Trauma Care

Background: Occupational therapists assess cognitive function in patients with traumatic brain injury (TBI) to determine the impact of impairments on occupational performance. In acute care settings, occupational therapists’ decision-making regarding the assessment of cognitive function is influenced by multiple factors. Aims: The aims of this study were to explore the perceived influences on choice of cognitive assessment by occupational therapists, the ways in which they incorporate observation of occupational performance in assessment, and their attitudes towards and experiences of implementing performance-based testing (PBT) in acute care. Methods: Fifteen occupational therapists with an average of 16.5 years of clinical experience working in acute care TBI management participated in an individual semi-structured interview. The interviews were conducted in person or online and consisted of six questions about which cognitive assessments they use in acute care, influences on this choice, and their experiences of assessing functional cognition using performance-based testing. Data were analysed using interpretive description. Results: The final four themes included (1) an emphasis on ‘functional observation of occupational performance’ and use of structured and tailored processes to make assessments, (2) ‘individualised and efficient’ assessment methods, (3) contextual influences on assessment choice, including the ‘occupational therapy department culture and hospital context’, and (4) ‘safety and management of risks’. Conclusions: Occupational therapy assessment of functional cognition in acute care depends on comprehensive understanding of individual patient-specific factors. Therapists are influenced by pragmatic factors when choosing assessments, which has led to the modification of standardised tests drawn from occupation-based approaches to fit within the time constraints of the acute care setting. The results indicate that therapists may benefit from guidance on how to safely assess patients’ functional cognition in an individualised way in the acute care setting. Full article

Background/Objectives: Concussions, their physical presentation, and patients’ recovery have been researched and documented numerous times, but the experiences of surviving and recovering from a concussion need to be explored further. The purpose of this study was to examine the lived experiences of NCAA Division I, II, and III student athletes who had suffered from one or more concussions. Methods: The consensual qualitative research (CQR) methodology was employed, guiding the formation of the interview questions and the analysis of the responses. The participants completed a free-response questionnaire as well as a semi-structured virtual interview that utilized a blend of idiographic, inductive, hermeneutic, and interpretive phenomenological approaches. Through their questionnaire and interview responses, they discussed their experience being concussed at a collegiate level. Results: Ten NCAA student athletes described their various physical, cognitive, emotional, and sleep-related symptoms due to receiving their concussion(s). Many of these student athletes reported feelings of loneliness, being misunderstood, or even not feeling “normal or at baseline” during and after their concussion recovery. One primary finding was the key role the athletic trainers played in the student athletes’ recovery process from initially receiving the concussion to their return to play. Conclusions: These findings will help contribute to the knowledge of what it is like to experience one or multiple concussions, the recovery process, and how that process can be improved. Full article

Background/Objectives: Hurricane exposure is a growing public health concern that frequently results in posttraumatic stress symptoms (PTSS) in families. Research suggests that contextual factors, including whether or not individuals evacuate, evacuation stress, perceived sense of control, and peritraumatic distress, contribute to PTSS development. Yet, no known research has evaluated how these variables relate to one another, limiting understanding of how and why evacuation-related circumstances impact PTSS. This study investigated how evacuation experiences and PTSS differ between hurricane evacuees and non-evacuees. Methods: Parents (N = 211) reported on their evacuation experiences and perceptions, as well as their and their child’s PTSS, following Hurricane Ian. Results: Evacuated participants reported greater evacuation stress and greater PTSS in themselves and their child relative to non-evacuated participants. Parents’ sense of control was negatively associated with parent evacuation stress and parent peritraumatic distress in the non-evacuated group only. There were no direct associations between parents’ sense of control and parent or child PTSS in either group. In the non-evacuated group, parent evacuation stress was indirectly related to parent PTSS via parents’ sense of control and parent peritraumatic distress. Similarly, parent evacuation stress was indirectly related to child PTSS via each of the aforementioned variables and parent PTSS in the non-evacuated group only. Conclusions: Stress associated with hurricane evacuation may impact parent’s perceived sense of control, which may contribute to greater parent peritraumatic stress, resulting in greater PTSS among parents and children within families that did not evacuate prior to a hurricane. Findings highlight mechanisms that may inform treatment interventions and public health policy. Full article

The management of penetrating rectal trauma has evolved from a historic 4-D algorithm (Divert, Drain, Direct repair, and Distal washout) to a more selective approach. This case report describes a patient with multiple wounds, including a high-grade extraperitoneal rectal injury resulting from a pelvic explosive injury. The patient was successfully treated with intraluminal vacuum therapy (ILVT). This case highlights ILVT as a novel method for managing complicated blast-related rectal injuries. While there are limited publications on combat-related penetrating rectal injuries that provide evidence-based guidelines, we suggest an aggressive surgical approach combined with negative pressure wound therapy for optimal patient outcomes. Full article

Background: Advancements in surgical wound management have led to improved healing and reduced complications. Incisional negative pressure wound therapy (iNPWT) is a technique that applies sub-atmospheric pressure to closed surgical wounds, enhancing blood flow, minimizing edema, and promoting tissue repair. Initially developed for chronic wounds, its use has expanded across multiple surgical specialties, including orthopaedic trauma surgery, to reduce complications such as dehiscence, infection, and prolonged healing. While traditional wound care relies on standard closure methods with simple dressings, iNPWT offers additional mechanical support and may lower the risk of deep surgical site infections (SSIs). This review examines the current evidence on iNPWT’s role in preventing SSIs following surgery for lower extremity fractures to guide clinical decision-making and improve patient outcomes. Methods: A systematic search through PubMed and MEDLINE utilizing our inclusion and exclusion criteria yielded seven randomized controlled trials and randomized prospective cohort studies that were subsequently analyzed to determine iNPWT effectiveness. Results: Of the seven studies, five showed a decreased SSI rate compared to standard wound dressing, with the other two exhibiting an increased infection rate. Conclusions: This review critically examines existing literature on iNPWT, analyzing level I and II studies on deep SSI rates in traumatic fractures. The evidence remains inconclusive on whether iNPWT offers a significant advantage over standard wound dressings, highlighting the need for further research to clarify its efficacy and clinical application. Full article

Introduction: The anatomy of the distal tibiofibular joint (DTFJ) has been demonstrated to influence the radiological outcome of reduction with syndesmotic screw fixation in the course of ankle fracture treatment. The objective of this study was to describe the anatomy of the DTFJ and to analyze the effect of incisura anatomy on syndesmotic stabilization with suture button systems (SBS), also in the context of their flexible nature of fixation. Materials and Methods: Forty-four (21 females, 23 males) consecutive postoperative bilateral computed tomography scans after stabilization of the DTFJ by SBS in the course of operative treatment of unstable ankle fractures were retrospectively analyzed. The anatomy of the DTFJ was evaluated by examining the following parameters: depth of the tibial incisura (DI), rotation of the incisura (ROI), Nault talar dome angle (NTDA), Leporjärvi clear space (LCS), anterior tibiofibular distance (antTFD), and fibula engagement (FE). The side-to-side (Δ) of LCS, NTDA, and antTFD, which analyzed the reduction result, were correlated with DI, FE, ROI, and NTDA, as well as the transverse offset (TO), reflecting the flexible nature of fixation. Results: Patients with slight overtightening (ΔLCS > −1 mm) showed a fibula that protruded less into the incisura on the native side (smaller FE) compared to symmetrical reduced patients and to patients with slight diastasis (p < 0.05). There was no relationship between the parameters describing the anatomy of the incisura and parameters assessing the parameter of the “flexible nature of fixation” (rs < 0.300). Regarding the anatomical parameters, it was observed that there were inter-individual differences of more than 4 mm (p > 0.05). Conclusions: The considerable inter-individual anatomical variability of the DTFJ was confirmed. The morphological configuration of the incisura has no impact on the immediate radiological reduction result after SBS stabilization of the DTFG, as determined by CT. The extent of the flexible nature of fixation is also not affected by the morphology of the incisura. Stabilization of the DTFJ can be performed regardless of the anatomical configuration. Full article

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