Trauma Care

Background/Objectives: Childhood trauma has a documented impact on development, and may also affect functioning and well-being in transition-age youth (TAY). There is a need to explore approaches, such as trauma-informed care (TIC), to enhance the services provided during the transition to adulthood. The objective of this scoping review was to explore the extent of the literature on the potential of TIC for supporting TAY. Methods: We focused on initiatives grounded in TIC to support TAY between the ages of 14 and 25 who have histories of trauma. The search strategy involved nine databases and the gray literature. The titles, abstracts, and full text were screened in duplicate by reviewers, and then data were extracted. Results: A total of 19 references were included and classified into three categories: (1) importance of TIC to support TAY (k = 5); (2) description of TIC initiatives (k = 6); and (3) evaluation of TIC initiatives supporting TAY (k = 2). Seven references were classified into more than one category. The references documented 10 TIC models or initiatives, half of which were evaluated and showed promising results. Important components of TIC initiatives supporting TAY included staff training and support; collaborative and multidisciplinary work; systemic changes; addressing trauma and its impacts; and a strength-based and youth-focused approach. Conclusions: The review emphasizes the importance of acknowledging and responding to trauma and its impact in TAY and advances the core components of TIC in the context of the TA, including its systemic nature. Although we cannot conclude that TIC is effective in supporting the TA at the moment—given that the literature is still in its early stages—the review shows that it is at least promising. Limitations, as well as future lines of work are discussed. Full article

Background and Introduction: Race-based social rejection has been found to predict post-traumatic stress and depression symptoms, consistent with previous studies that have shown the negative mental health effects of racism, as well as social rejection in general. While racial identity has been noted as a protective factor among African Americans, the role it plays in the context of race-based social rejection is less clear. Methods: This study examines the relationships among self-reported race-based social rejection, hypothesized protective factors, and negative psychological outcomes among a sample of 230 low-income, urban African American men and women. Results: Multiple regression analyses revealed that racial identity did not moderate the race-based social rejection–depression relationship. However, it exacerbated post-traumatic stress symptoms in the face of race-based social rejection. Discussion: These results suggest that when one perceives such rejection, identifying strongly with one’s group may amplify post-traumatic stress by triggering collective instances of racial trauma. Conclusions: The role of racial identity highlights the unique nature of racial trauma, involving the interplay of individual and social facets, particularly among those who highly identify with their racial group, and call for collective and creative solutions. Full article

Objectives: this study aimed to compare the admission volume and characteristics of patients with traumatic orthopaedic injuries before, during, between, and after the COVID-19 lockdowns in metropolitan Victoria, Australia. Methods: A multi-centre, registry-based cohort study with an interrupted time series analysis was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) for patients with a date of injury from January 2017 to June 2022. Weekly admission volume, injury event characteristics, and in-hospital outcomes were analysed before, during, between, and after the two periods of COVID-19 lockdowns in metropolitan Melbourne (i.e., five periods). Results: During the first week of lockdown in Victoria (L1), the number of weekly orthopaedic trauma admissions declined by 24% relative to the preceding week, IRR 0.76 (95%CI 0.67, 0.87). However, the volume of admissions during the subsequent lockdown (L2) approximated pre-COVID levels. An immediate increase in orthopaedic trauma admissions occurred during the intermission (time between lockdowns) and post-COVID periods by 33% and 20%, respectively, compared to the preceding week. During periods of lockdown, patients were older (61 versus 58 years old), and a higher proportion were injured at home (38% versus 28%); fewer due to motor vehicle collisions (8% versus 11%). The pattern of injury by intent, body region injured, injury severity, and in-hospital mortality were unchanged. Conclusions: the impact of COVID-19 lockdowns on the volume and characteristics of hospitalised orthopaedic trauma was not uniform across consecutive lockdowns, but favoured injuries that occurred at home. Full article

Background: Internal displacement is a global crisis, with Ethiopia being among the most affected countries due to conflict, violence, and natural disasters. Internally displaced people (IDPs) face multifaceted trauma at the individual, family, and community levels, exacerbating mental health issues such as PTSD and depression. Despite ongoing interventions, many programs lack cultural and contextual adaptations that are suited to Ethiopia’s diverse communities. Aims: This study aimed to explore the cultural and contextual factors influencing trauma-informed interventions for IDPs in Ethiopia and develop a framework for culturally responsive mental health support. Methods: Utilizing Community-Based Participatory Action Research (CBPAR) and interpretative phenomenological research design, data were collected from 42 stakeholders through Focus Group Discussions and in-depth individual interviews, and subsequently analyzed using thematic analysis to identify patterns and themes. Results: Key findings highlighted the ongoing trauma faced by IDPs, the importance of demographic characteristics (e.g., gender and education), and the role of cultural stereotypes in shaping trauma perceptions. Traditional community rituals such as coffee ceremonies have been identified as vital for healing. Effective interventions require cultural alignment, respect for religious values, and integration into community activities. Conclusions: This study underscores the need for culturally and contextually responsive trauma-informed intervention. Incorporating community rituals and engaging local leaders enhances intervention acceptance and effectiveness. The findings provide a framework to address mental health needs while fostering resilience among internally displaced Ethiopian populations. Full article

Background: Exposure to traumatic experiences has been positively associated with college students’ academic difficulties and psychological distress. However, little is known about the traumatic events experienced by Hispanic college students. This study examined the types of lifetime traumatic events experienced by Hispanic college students, including immigration enforcement-related events, and the association between events and psychological distress. Methods: College students (N = 1112) completed self-reported measures assessing lifetime traumatic experiences, post-traumatic stress disorder (PTSD) symptoms, and depression symptoms. Results: Most participants (81%) were born in the US, and most (84%) reported that at least one parent was foreign born. Hispanic students reported similar types of traumatic events reported by the general population of college students in previous studies. In addition, many students reported immigration-related potentially traumatic events. The following types of traumatic events were most strongly associated with greater levels of psychological distress: sexual assault or molestation, life-threatening illnesses or accidents, verbal abuse, physical or verbal bullying or mistreatment, directly experienced immigration enforcement events, and having witnessed physical or verbal abuse of someone close. Conclusions: It is important that clinicians use a broad definition of potentially traumatic events in the identification and treatment of Hispanic college students who may have experienced PTSD or depression symptoms following major life events, including immigration enforcement events. Full article

Background/Objectives: Intentional injury due to violent acts is associated with significant morbidity and mortality. However, intentional traumatic brain injury (TBI) has received little attention and there is limited research on the relationship of injury intent to injury mechanism, severity, mortality, hospital disposition and demographic factors. In this study, the aim was to examine the factors associated with intentional TBI and evaluate the differences in outcomes based on injury intent. Methods: We conducted a retrospective analysis of patients with diagnosed TBI at an urban trauma center. Hospital data were obtained from the Department of Surgery’s trauma registry for the years 2017–2022. Intentional and unintentional TBI patients were compared using descriptive, univariate and multivariate methods. Results: In this study, 123 (9.28%) intentional TBIs and 1203 (90.72%) unintentional TBIs were identified. Younger age, male gender, minority status, Medicaid coverage, alcohol use and the lack of orthopedic injury were associated with intentional TBI. Patients with intentional TBI were more likely to be discharged to home and with admissions had shorter hospital lengths of stay and were less likely to be discharged to rehabilitation. Multivariate analysis found that Black race and alcohol use near the time of injury were predictive of intentional injury when adjusting for other demographic variables. Conclusions: Overall, patients with intentional TBI had less severe and more focal injury events with shorter hospital stays if admitted. Multiple demographic- and injury-related variables were associated with intentional TBI. Further study is needed to evaluate the long-term patient outcomes and re-injury after intentional TBI. Full article

Background/Objectives: This systematic review aimed to investigate the efficacy of methylphenidate medication in the treatment of cognitive problems, such as attention, following pediatric traumatic brain injury. Previous reviews have focused on a broader population of acquired brain injury in pediatrics. Methods: Six databases were systematically searched, and eleven relevant reports were included, of which five were randomised controlled trials (RCTs) and six were prospective cohort designs with no control arm. The risk of bias was assessed for each of the studies using appropriate tools. Results: Eleven studies were included in this study for data extraction consisting of 376 participants. Our primary outcome of the efficacy of methylphenidate in improving attention was assessed in the included studies using a variety of tools. A meta-analysis was only possible for studies using the continuous performance test data, which showed an overall insignificant reduction of 36.07 (95% CI [−96.94, 24.80], p = 0.25). Other outcomes, such as the Conners’ rating scale and the behaviour rating interview of executive function, also did not show an overall difference after methylphenidate treatment. However, the risk of bias across all studies was judged as moderate to high. Conclusions: We conclude that there is currently no evidence to support the use of methylphenidate to improve cognitive outcomes in pediatric traumatic brain injury patients. Significantly larger high-quality studies are needed to determine an effect on executive functioning outcomes after methylphenidate treatment in pediatric traumatic brain injury. Full article

Background/Objectives: Hypothermia can affect multiple organ systems and reduce patient comfort and is an independent predictor of mortality in trauma patients. Early prevention and management prehospitally is critical and can be approached by “warming” patients using active and/or passive measures. Therefore, this systematic review aimed to determine the efficacy of prehospital active warming (AW) in trauma patients. Methods: MEDLINE, Embase, Web of Science and CENTRAL were searched up to June 2024 for studies meeting our inclusion and exclusion criteria. Six studies were identified: four randomised controlled trials (RCTs), a non-randomised trial and an observational study. A risk-of-bias assessment was conducted using either the Cochrane Risk of Bias 2 tool or the ROBINS-I tool. Results: For the primary outcome of end core body temperature (CBT), our meta-analysis calculated a statistically significant mean difference of 0.62 °C ([95%CI: 0.17, 1.07], p = 0.007), favouring AW. For the secondary outcomes of end heart rate and end systolic blood pressure, the mean differences favoured the AW and control groups, respectively, but were not statistically significant (p = 0.45 and p = 0.64). Two of the four RCTs had an overall moderate to high risk of bias, whilst the two observational studies had a high risk of bias. Conclusions: Overall, our results suggest that AW may be effective at managing CBT, but our results are limited by a small sample size, a serious/high overall risk of bias and variable study characteristics. Larger, high-quality studies are needed to inform clinical practice and guidelines. Full article

Classical medical education teaches history and physical skills using scenarios wherein the criticality of a patient is predefined. This educational approach creates a gap in medical knowledge for students, who do not regularly define or establish patient criticality, and this gap is realized when it comes to the triage and management of critical patients. The purpose of this paper is to define an approach to patient assessment and management that is accessible to medical students regardless of criticality. This approach is algorithmic and defined by the use of three steps: (1) a primary survey, during which a general impression of the patient is formed, ABCDEs are assessed, and a criticality assessment is made; (2) a secondary survey, during which vitals, history, and exam data are all collected to form a working diagnosis; and (3) plan and treatment, during which supportive diagnostics, such as labs, imaging, and testing, are performed in the service of patient stabilization and intervention, consults/referrals are ordered/placed, and a final disposition is established. This model is intended to complement existing medical education and further expand it to encompass both critical and noncritical patients. Full article

Traumatic brain injury (TBI) is a significant public health issue among Medicare beneficiaries, with many specialties reporting consistent annual decreases in utilization and reimbursement. This study investigates the trends in Medicare utilization and rates of reimbursement for neurosurgical procedures related to TBI from 2003 to 2021, aiming to provide insights into the economic aspects of TBI care. Utilizing the Medicare Part B National Summary Data files, we analyzed 14 neurosurgical procedures over the 18-year period, assessing the changes in procedural volume and mean reimbursement per procedure, adjusted for inflation to the 2021 USD using the Consumer Price Index. From 2003 to 2021, TBI-related neurosurgical interventions showed a total percent change of −15.39% in procedural volume and −3.11% in inflation-adjusted mean reimbursement per procedure. Linear regression analyses indicated a significant downward trend in the overall procedural volume (p < 0.001) but no significant trend in the inflation-adjusted mean reimbursement rates (p = 0.585). Subgroup analyses did not reveal significant changes in the reimbursement rates for decompressive craniotomy/craniectomy, cranioplasty, intracranial pressure management, and traumatic fracture/penetration procedures. Our study indicates a significant decrease in neurosurgical TBI procedural volumes, while reimbursement rates remained stable when adjusted for inflation, highlighting the need for policy adjustments to ensure adequate resources for TBI care. Full article

Social determinants of health (SDoH) are nonmedical factors impacting health outcomes. We evaluated the relationship between the county-level measure of SDoH and county-level fatal crash counts among geriatric and non-geriatric road users. We pooled data from the Fatality Analysis Reporting System and limited our analyses to the 3108 contiguous US counties. The outcome measures were county-level fatal crash counts involving (1) geriatric (65 years and older), (2) non-geriatric, and (3) all road users. The predictor variable was the multidimensional deprivation index (MDI), a composite measure of SDoH, measured as a three-level categorical variable defined as very highly deprived, highly deprived, and average-to-low deprived. We performed a Bayesian spatial Poisson regression analysis using integrated nested Laplace approximations and reported the adjusted crash fatality rate ratios (plus 95% credible intervals (CrI)). The median (Q1, Q3) standardized mortality rate ratios among geriatric and non-geriatric road users were 1.3 (0.6, 2.5) and 1.6 (0.9, 2.7), respectively. Counties classified as very highly deprived had 23% (95% CrI: 1.10–1.38) and 20% (95% CI: 1.08–1.32) increased geriatric and non-geriatric fatality crash rate ratios. In conclusion, improving county-level SDoH may reduce the county-level fatal rate ratios equally among geriatric and non-geriatric road users. Full article

Objective: To investigate whether the relationships between acute care occupational therapy (OT) and physical therapy (PT) utilization and community discharge are moderated by functional or physical performance at discharge among individuals hospitalized with traumatic brain injury (TBI). Setting: 14 acute care hospitals in the state of Colorado. Participants: We studied 5599 adults hospitalized with TBI between June 2018 and April 2021. Design: In a secondary analysis of de-identified electronic health record (EHR) data, multivariable moderation logistic regression models were performed to calculate odds ratios (ORs) for the likelihood of community discharge among patients who utilized OT/PT services. Main Measures: Functional (activities of daily living [ADL]) and physical (mobility) performance at discharge, OT and PT utilization, and community discharge status. Results: Overall, 67% of patients discharged to the community. The mean age of the sample was 55 years (SD = 20 years). Most participants were male (64%) and non-Hispanic White (72%). Mean hospital length of stay was 6 days (SD = 6 days). Both OT and PT utilization (OT: OR = 1.21, 95% CI [1.11, 1.33]; PT: OR = 1.22, 95% CI [1.14, 1.30]) and discharge ADL and mobility scores (ADL: OR = 1.34, 95% CI [1.30, 1.39]; mobility: OR = 1.38, 95% CI [1.33, 1.42]) were significantly and positively associated with community discharge. The OT and PT utilization-by-discharge ADL and mobility interaction terms yielded slightly negative, but statistically significant moderation effects in both models (ORs = 0.99, 95% CIs [0.98, 1.00]); indicating the magnitude of the OT and PT utilization effect diminished as ADL and mobility scores increased. Several sociodemographic characteristics and clinical factors were also independently associated with community discharge in both models (p-values < 0.001–0.04). Conclusions: Greater OT and PT utilization was associated with increased odds of community discharge. Similarly, higher ADL and mobility scores at discharge were associated with increased odds of community discharge. The small, but statistically significant negative interaction terms in both models indicated that the magnitude of the OT and PT utilization effect diminished as ADL and mobility scores increased. This study’s findings can guide occupational and physical therapists in their efforts to facilitate a safe transition to the community for patients with TBI. Full article

Background: The effects of adverse childhood experiences on adult psychopathology have received ample attention in empirical studies. Despite the extensive focus on the effects of childhood adversity, research on the protective factors that might mitigate these effects remains limited. The most common measure of childhood adversity is the Adverse Childhood Experiences (ACEs) questionnaire. In 2016, a novel addition, called the ‘Protective and Compensatory Experiences’ (PACEs) questionnaire was created to be administered in tandem with the ACEs measure. Objective: Developing an understanding of PACEs can provide insight into the positive impacts of protective factors and potential ways to build resiliency among those with adversity. The aim of the present review is to provide an overview of the uses and findings of the PACEs measure and its potential contributions in the field. Methods: A literature search was used to identify peer-reviewed publications, dissertations, and conference presentations on empirical data, reporting on the administration of the PACEs measure to a clinical or community population and their findings. Results: A total of 17 studies were identified that used the PACEs. Ten empirical studies were used to explore the impact of PACEs within the realm of child development, including research on pregnant mothers, parenting, and child resilience. Six empirical studies were used to investigate the prevalence of PACEs in various at-risk populations, such as sexual minorities, racial minorities, veterans, individuals with chronic pain, and healthcare providers after the COVID-19 pandemic. One empirical study used PACEs to track attrition in longitudinal research studies. Conclusions: Overall, there appears to be little research on the PACEs, but the empirical studies that we identified suggest that PACEs may increase resiliency among various populations. Future research into positive and negative childhood experiences would benefit from the information assessed with the PACEs measure. Full article

Moral injury is a psychological wound resulting from deep-rooted traumatic experiences that corrode an individual’s sense of humanity, ethical compass, and internal value system. Whether through witnessing a tragic event, inflicting injury on others, or failing to prevent a traumatic injury upon others, moral injury can have severe and detrimental psychological and psychosomatic outcomes that may last a lifetime. Post-traumatic experiences do not have to be a permanent affliction, however. From moral injury can come post-traumatic growth—the recovery from trauma in which personal betterment overshadows moral injury. Moral injury may lead to substantial personal growth, improved capacity and resilience. Based on these observations, it seems that from struggles and darkness, there can be positivity and hope. This review will summarize the current concepts of post-traumatic growth and consider potential mechanisms leading to resilience and recovery through post-traumatic growth. These considerations are gaining more importance in light of a growing number of existential threats, such as violent conflicts, natural disasters and global pandemics. Full article

Existing literature thoroughly reviews the detrimental consequences that adverse childhood experiences (ACEs) have physically, emotionally, neurobiologically, and financially. It is imperative to develop effective treatments that offer a sense of hope to children who have been impacted. The established relationship between high ACE scores and physiological hyperarousal due to emotional dysregulation is clear in the literature. This relationship indicates that taking psychophysiological measures may be an effective method of gauging the effectiveness of trauma treatments. This study measured the heart rate of a child who had experienced multiple ACEs, during 16 child-centered play therapy (CCPT) sessions, using the Empatica (E4) wristband. Bayesian change point analysis was conducted and multiple changes in the heart rate mean were detected and identified within each session’s time series. Additionally, changes in heart rate variability during the 16 sessions were observed and points of interest, e.g., highest and lowest observed heart rates, were noted. Results suggested the number of breakpoints in the heart rate means within each session, as well as the location, i.e., the time of each breakpoint, so that each significantly detectable change in heart rate mean as well as sessions of noted differences in heart rate variability were discussed alongside what was occurring within the video recorded sessions. Full article

We report the case of a 44-year-old woman who suffered gastric perforation after receiving bag-valve-mask (BVM) ventilation in the setting of alcohol intoxication. She had a markedly distended abdomen and cold, dusky lower extremities upon arrival to the emergency department. Imaging revealed a large volume intra-abdominal accumulation of air with compression of the aorta. Needle decompression relieved symptoms of lower extremity arterial insufficiency. However, the patient quickly decompensated and subsequent exploratory laparotomy confirmed gastric rupture. A subtotal gastrectomy was performed but the patient ultimately passed on post-operative day two due to multi-organ dysfunction. Although BVM ventilation is commonplace in both the hospital and field, there is a lack of awareness of the serious complications of abdominal air accumulation due to their rareness in the adult population. Checking for abdominal distention during resuscitation ought to be routine in all patients. Signs of arterial insufficiency accompanying abdominal distention, once confirmed by diagnostic imaging that shows extensive pneumoperitoneum, are indicators of having reached a life-threatening level of air accumulation, calling for immediate needle decompression and exploratory laparotomy. Full article