Trauma最新文献

{"title":"Effect of trauma type and trauma burden on self-efficacy for physical exercise in military veterans","authors":"K. Davis, Meghan M Bennett, Cecilia J. Hillard, Jeffrey Whittle, Zeno Franco, Rachel E Bollaert, Jacklynn M Fitzgerald","doi":"10.1177/14604086241231373","DOIUrl":"https://doi.org/10.1177/14604086241231373","url":null,"abstract":"United States (U.S.) military veterans experience significant physical health problems. Lifestyle modifications, such as increasing daily physical activity, are often considered the first course of action in treatment for the general public. However, veterans report low levels of physical activity, often due to perceived barriers to engaging in exercise. Trauma exposure type and cumulative trauma burden may be differentially associated with exercise attitudes and behaviors. We surveyed U.S. military veterans on perceived self-efficacy to overcome barriers to engaging in exercise and physical activity levels. Additionally, we explored the relationship between the type of traumatic event exposure and cumulative trauma on these constructs. Veterans exposed to sexually aggressive traumatic events (vs. did not) reported significantly lower physical activity levels; no difference in perceived self-efficacy to overcome barriers to exercise existed between groups. Greater cumulative trauma was associated with lower physical activity and self-efficacy to engage in exercise. These novel results indicate that both trauma type and cumulative trauma burden should be considered when designing exercise interventions for military veterans.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"11 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140441922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic sarcopenic obesity measurements in elderly trauma patients do not predict adverse discharge disposition over injury severity score","authors":"John S. Oh, Christine M. Peterson, Carolina Alvarez, Stephen C. Layng, Sandeep Pradhan, Chan Shen, Jungeun Jasmine Lee, Nicole M. Osevala, S. Armen","doi":"10.1177/14604086241229266","DOIUrl":"https://doi.org/10.1177/14604086241229266","url":null,"abstract":"There is a need for a predictive tool for adverse discharge disposition in the injured elderly patient population. However, many measurements of frailty are not practical and radiographic measurements of muscle and adipose tissue have yet to be correlated with adverse discharge disposition in this population. A retrospective review of a prospectively gathered trauma database at a level one trauma center was performed, studying all adult trauma patients aged 55 years or older with an inpatient stay of greater than 2 days. Patients with a non-survivable head trauma (head Abbreviated Injury Score of 6) or serious central nervous system injury, history of cirrhosis or solid organ transplantation, those actively being treated with immunosuppressive medications, and those without an abdominal computerized tomography (CT) scan within the first 48 h of admission were excluded. Sarcopenia, sarcopenic obesity (SO), and five-item frailty index (5-iFI) score were obtained and analyzed against adverse discharge disposition. The study evaluated 444 patients, of which 48.9% were male with a median age of 78 years (range 55–99 years). All patients sustained blunt trauma, shock index was positive in 13.7%, and median ISS was 10 (range 1–43). SO was not independently predictive of adverse discharge disposition. Additionally, neither sarcopenia nor 5-iFI scores were found to be independently predictive. Lower ISS and age were found to be protective against adverse discharge disposition. CT-based measurements of muscle and adipose tissue may not add value over traditional injury scores in older trauma patients.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"271 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139842579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic sarcopenic obesity measurements in elderly trauma patients do not predict adverse discharge disposition over injury severity score","authors":"John S. Oh, Christine M. Peterson, Carolina Alvarez, Stephen C. Layng, Sandeep Pradhan, Chan Shen, Jungeun Jasmine Lee, Nicole M. Osevala, S. Armen","doi":"10.1177/14604086241229266","DOIUrl":"https://doi.org/10.1177/14604086241229266","url":null,"abstract":"There is a need for a predictive tool for adverse discharge disposition in the injured elderly patient population. However, many measurements of frailty are not practical and radiographic measurements of muscle and adipose tissue have yet to be correlated with adverse discharge disposition in this population. A retrospective review of a prospectively gathered trauma database at a level one trauma center was performed, studying all adult trauma patients aged 55 years or older with an inpatient stay of greater than 2 days. Patients with a non-survivable head trauma (head Abbreviated Injury Score of 6) or serious central nervous system injury, history of cirrhosis or solid organ transplantation, those actively being treated with immunosuppressive medications, and those without an abdominal computerized tomography (CT) scan within the first 48 h of admission were excluded. Sarcopenia, sarcopenic obesity (SO), and five-item frailty index (5-iFI) score were obtained and analyzed against adverse discharge disposition. The study evaluated 444 patients, of which 48.9% were male with a median age of 78 years (range 55–99 years). All patients sustained blunt trauma, shock index was positive in 13.7%, and median ISS was 10 (range 1–43). SO was not independently predictive of adverse discharge disposition. Additionally, neither sarcopenia nor 5-iFI scores were found to be independently predictive. Lower ISS and age were found to be protective against adverse discharge disposition. CT-based measurements of muscle and adipose tissue may not add value over traditional injury scores in older trauma patients.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"14 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139782837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of levetiracetam dosing for seizure prophylaxis in traumatic brain injury","authors":"Alixandra Mann, Kristen Livers, Christine Duff Frick, Michael W. Daniels, Emily Sieg, Michelle Bailey, Lindsay Weitkamp","doi":"10.1177/14604086241230598","DOIUrl":"https://doi.org/10.1177/14604086241230598","url":null,"abstract":"Early post-traumatic seizures (PTSs) may occur within seven days of traumatic brain injury (TBI). Although levetiracetam is frequently used for early PTS prophylaxis, it is not recommended in current guidelines due to insufficient evidence. The objective of this study was to further evaluate levetiracetam dosing strategies for early PTS prophylaxis. A single-center retrospective cohort study was conducted utilizing the electronic medical record and a trauma database. The primary outcome was an incidence of seizure within seven days of TBI, defined as any documentation of a seizure when utilizing low-dose levetiracetam (500 mg twice daily), compared to high-dose levetiracetam (>500 mg twice daily). Subgroup analyses were performed based on mechanism of injury, trauma type, baseline Glasgow Coma Scale (GCS), injury severity score (ISS), and Augmented Renal Clearance in Trauma Intensive Care score, administration of a loading dose, and additional head injuries. Only patients who completed a full seven-day course of levetiracetam were included. Of the 203 patients included, 149 patients received low-dose levetiracetam and 54 patients received high-dose. The majority of patients had a GCS < 8 (53.7%) and an ISS > 15 on presentation (92.1%). Twelve of 203 patients (5.9%) experienced a seizure within seven days of TBI, which is similar to the rate seen in previous studies. Six patients in the low-dose group (4.0%) and six patients in the high-dose group (11.1%) experienced a seizure ( p = 0.059). There was no statistically significant difference in seizure rate when patients were stratified based on baseline GCS, ISS, or mechanism of injury. There were no statistically significant differences in seizure rates when comparing low-dose to high-dose levetiracetam. Levetiracetam 500 mg twice daily may be as effective as levetiracetam doses >500 mg twice daily for early onset post-traumatic seizure prophylaxis.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"77 17-18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139856555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of levetiracetam dosing for seizure prophylaxis in traumatic brain injury","authors":"Alixandra Mann, Kristen Livers, Christine Duff Frick, Michael W. Daniels, Emily Sieg, Michelle Bailey, Lindsay Weitkamp","doi":"10.1177/14604086241230598","DOIUrl":"https://doi.org/10.1177/14604086241230598","url":null,"abstract":"Early post-traumatic seizures (PTSs) may occur within seven days of traumatic brain injury (TBI). Although levetiracetam is frequently used for early PTS prophylaxis, it is not recommended in current guidelines due to insufficient evidence. The objective of this study was to further evaluate levetiracetam dosing strategies for early PTS prophylaxis. A single-center retrospective cohort study was conducted utilizing the electronic medical record and a trauma database. The primary outcome was an incidence of seizure within seven days of TBI, defined as any documentation of a seizure when utilizing low-dose levetiracetam (500 mg twice daily), compared to high-dose levetiracetam (>500 mg twice daily). Subgroup analyses were performed based on mechanism of injury, trauma type, baseline Glasgow Coma Scale (GCS), injury severity score (ISS), and Augmented Renal Clearance in Trauma Intensive Care score, administration of a loading dose, and additional head injuries. Only patients who completed a full seven-day course of levetiracetam were included. Of the 203 patients included, 149 patients received low-dose levetiracetam and 54 patients received high-dose. The majority of patients had a GCS < 8 (53.7%) and an ISS > 15 on presentation (92.1%). Twelve of 203 patients (5.9%) experienced a seizure within seven days of TBI, which is similar to the rate seen in previous studies. Six patients in the low-dose group (4.0%) and six patients in the high-dose group (11.1%) experienced a seizure ( p = 0.059). There was no statistically significant difference in seizure rate when patients were stratified based on baseline GCS, ISS, or mechanism of injury. There were no statistically significant differences in seizure rates when comparing low-dose to high-dose levetiracetam. Levetiracetam 500 mg twice daily may be as effective as levetiracetam doses >500 mg twice daily for early onset post-traumatic seizure prophylaxis.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"53 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139796992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From case to context: A case-driven comprehensive review on Kirschner wire migration to the cervical spine and neck","authors":"J. Hrubovčák, Ľ. Tulinský, Petr Jelínek, Slavomír Potičný, Jan Roman, Jiří Szeliga","doi":"10.1177/14604086231225361","DOIUrl":"https://doi.org/10.1177/14604086231225361","url":null,"abstract":"Osteosynthesis using Kirschner wires constitutes a fundamental technique within the realms of traumatology and orthopaedics. Despite its widespread application and popularity, it is susceptible to migration of the wires. A 36-year-old patient presented with neck pain; subsequent radiographic imaging identified two Kirschner wires that had migrated to the cervical spine following failed removal after K-wiring of a fractured left clavicle 16 years previously. Surgical removal was undertaken complicated by a parapharyngeal abscess that needed surgical drainage and neurological symptoms in terms of left shoulder weakness and left arm/hand paraesthesia. All neurological symptoms resolved after many months of rehabilitation excepting some residual paraesthesia on the ulnar border of the left hand. A thorough literature review reveals 30 other cases of K-wire migration to the cervical spine. Vague symptoms are the norm with <25% presenting focal neurological symptoms, with only 6 penetrating the spinal cord, two of which were left with severe deficits. The other 28 patients had no long-term significant deficits. The migration of K-wires into the spinal canal, is a rare but recognised complication. Functional outcomes are contingent on spinal cord injuries arising from the implantation. In the absence of spinal cord injury, a high probability of complete functional restoration and symptom resolution exists.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"328 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140472228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of pre-existing psychiatric illness on traumatic brain injury outcomes: A propensity-matched cohort study","authors":"Francisco Benavides, Jorge Liporaci, John Getchell, Jason Weinberger, Richard Caplan, Elianne Rojas, Andrea Kaspresnki, Luis Cardenas","doi":"10.1177/14604086231187157","DOIUrl":"https://doi.org/10.1177/14604086231187157","url":null,"abstract":"There are limited data on how patients with pre-existing psychiatric disorders fare after sustaining a traumatic brain injury (TBI). The purpose of this study was to evaluate the impact of pre-existing psychiatric illness on clinical outcomes after TBI. A retrospective review was conducted at a regional level 1 trauma center of patients who suffered a TBI between 2012 and 2020. Propensity scores were used to match patients with psychiatric disorder 1:1 to controls. The matched population was used in analyses. Totally, 5343 patients sustained TBI in the study period of which, 977 (18%) had a pre-existing psychiatric disorder. These patients had 1.6 times longer hospital length of stay (LOS) and 1.2 times longer ICU LOS, though days on a ventilator were not longer. TBI readmission, unrelated to the initial head injury, which was more frequent for patients with psychiatric disorder (OR = 2.6 [1.5, 4.6]). In patients sustaining a TBI, having a pre-existing psychiatric disorder is an independent risk factor for increased LOS, and TBI readmission. Identifying psychiatric patients as being of higher risk may allow for targeted modifications toward head injury prevention.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"121 43","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139605352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between post-injury chronic physical health conditions, health status, and survival time in people with serious orthopaedic injuries","authors":"A. Gelaw, Belinda J Gabbe, Sarah J. Arnup, Sandra Reeder, Mark Fitzgerald, R. Lyons, J. Ponsford, Alex Collie, Nicola Christie, Andrew Nunn, James E Harrison, Peter Cameron, C. Ekegren","doi":"10.1177/14604086231216180","DOIUrl":"https://doi.org/10.1177/14604086231216180","url":null,"abstract":"A better understanding of how chronic physical health conditions affect long-term outcomes following injury is essential for quantifying the burden of serious orthopaedic injuries. We aimed to describe the association between the presence of post-injury chronic physical health conditions and (i) the change in health status from before injury to six different follow-up time points after injury; and (ii) survival time. A cohort study was conducted using linked data from the REcovery after Serious Trauma: Outcomes, Resource Use, and Patient Experiences study, the Victorian Registry of Births, Deaths and Marriages (BDM) (2009–2017), the victorian admitted episodes dataset (2009–2017) and the victorian emergency minimum dataset (2009–2017). Adults (≥ 18 years old) with serious orthopaedic injuries who survived to discharge from their trauma admission were included. Multivariable linear regression analysis was conducted to evaluate the association between post-injury chronic physical health conditions and the mean change in health status (EuroQol-Visual Analogue Scale) from before injury to six follow-up time points post-injury. Survival analysis was conducted to estimate the probability of survival for people with and without chronic physical health conditions following injury. Out of 894 participants, 177 (19.8%) had at least one chronic physical health condition recorded up to five years post-injury. People with post-injury conditions reported a greater mean decline in health status than people without post-injury conditions (difference, (95% CI): −6.9 (−9.7, −4.2), p = 0.01). Over the study period, almost six times as many people with chronic physical health conditions post-injury died as people without these conditions (AHR (95% CI): 5.7 (2.9, 11.3), p < 0.01). Chronic physical conditions after serious orthopaedic injuries were associated with a lower survival probability and a deteriorating health status. Orthopaedic injury survivors may benefit from early detection and treatment of chronic conditions.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139604036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of delayed CSF leakage from the sphenoid sinus due to a stabbing","authors":"A. Tabibkhooei, Parisa Javadnia, A. Fattahi","doi":"10.1177/14604086231210230","DOIUrl":"https://doi.org/10.1177/14604086231210230","url":null,"abstract":"A patient with a non-missile penetrating brain injury might present fully conscious without any neurological deficit with a small linear laceration on skull as the only sign of injury. We present a 27-year-old man who was referred to us with new onset CSF leakage as rhinorrhea and history of penetrating stab wound injury to his right temporal region, 3 months ago. The imaging showed the tract of removed sharp object which was piercing the calvaria and the temporal lobe from the right temporal bone, entering the lateral wall of the cavernous sinus, adjacent to the siphon of the carotid artery till the lateral wall of the right sphenoid sinus, ultimately its distal tip entered the sphenoid sinus. The patient was treated through an endoscopic endonasal approach to repair the defect of his skull base. As a result, we should be cautious in facing these patients even if they are asymptomatic. Also doing complementary imaging modalities and other evaluations are crucial to not ignore any possible complications based on their history and examinations.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"26 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139608019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absence of July effect on trauma outcomes at the start of the academic medical calendar","authors":"L. Zima, J. Harvin, Hansen Deng, David Okonkwo, Emily Sieg, Ahmad Alhourani, Jonathan R. Jagid, Evan Krueger, S. Taghavi, Kristen Nordham, Glenda Torres, Stefan Lang, Artur Vetkas, Ryan S Kitagawa, Andres Lozano, Christopher R Conner","doi":"10.1177/14604086231206308","DOIUrl":"https://doi.org/10.1177/14604086231206308","url":null,"abstract":"The “July effect” refers to the phenomenon of a higher complication incidence and lower survival rate for patients treated at academic institutions during the beginning of the academic medical calendar. To date, no multi-center study has examined the presence of a “July effect” in a large cohort of trauma patients. We sought to determine if there is a by-month effect on survival and length of stay (LOS) for trauma patients in large academic centers. We performed a multicenter, retrospective cohort study between 2010 and 2020 from five high-volume academic trauma centers in the United States. We included all adult motor vehicle collision (MVC) traumas evaluated at all centers in the study population (age >16 years, mechanism of injury classified as “motor vehicle collision”). Data included date and time of injury, injury severity score (ISS), LOS, and mortality. Each injury was classified as minor (ISS 1–8), moderate (9–15), severe (16–24), and very severe (>25). The mortality and LOS for each range over the entire epoch was calculated by month for each ISS classification. We analyzed 39,668 MVC traumas (mean age 41.83, range 39.9–43.3 among sites, 58.9% male and range 56.1–60.4%, 67.4% white range 42.3–84.7%). Survival for the “very severe” traumas ranged from 86.7–90.3%. Across the five sites, there was no significant change in survival (either increased or decreased mortality) or LOS for MVC patients in July or August for any injury classification level. Both age and ISS had a significant effect on survival (OR 0.02 for ISS >25, 0.22 for patients >65 years-old, both p < 0.05). In five high-volume centers, there was no significant effect of the July transition on survival or LOS of MVC trauma patients.","PeriodicalId":515287,"journal":{"name":"Trauma","volume":"18 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139607140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}