Trauma Care doi: 10.3390/traumacare6020010

Authors: Jessica Zapata Domhnall O’Dochartaigh Kym Boyko Daniel Garros Fadi Hammal Ruth Bird

Background: Recreational motorized vehicles, including all-terrain vehicles (ATVs), dirt and motor bikes, snowmobiles, and e-scooters, are an increasingly recognized source of severe trauma among children. Adult provincial data from Alberta demonstrate high morbidity, mortality, and more than $6 million in acute care costs from ATV-related injuries over a decade; however, pediatric injury patterns remain under-characterized despite rising exposure. Methods: We conducted a retrospective cohort study of pediatric patients presenting with major trauma (Injury Severity Score > 12) to the Stollery Children’s Hospital between December 2019 and June 2023. Recreational motorized vehicle-related cases were analyzed for demographics, injury mechanisms, injury severity, hospital resource utilization, and clinical outcomes. Available Abbreviated Injury Scale data were reviewed descriptively for a subset of ATV-related injuries. Results: Of 345 pediatric major trauma cases, 55 (16%) involved recreational motorized vehicles, accounting for 17% of major blunt trauma presentations. ATVs were the most common mechanism (58%), followed by dirt/motor bikes (23.6%), snowmobiles (14.5%), and e-scooters (3.6%). Patients were predominantly male (72.7%) with a mean age of 13.1 years. Operative intervention was required in 58.2% of cases, 30.9% required pediatric intensive care unit admission, and mortality was 5.5%. Helmet status was incompletely documented; only 36.4% of patients were recorded as wearing helmets. Children from rural regions accounted for 43.6% of injuries. In the ATV subset with available AIS data, head, facial, and extremity injuries were most common, and all patients sustained at least one serious injury (AIS ≥ 3). Conclusions: Recreational motorized vehicles represent a substantial and preventable cause of severe pediatric trauma in Alberta. When contextualized with adult provincial data demonstrating significant mortality and healthcare costs, these findings support strengthened injury-prevention strategies, improved safety enforcement, and evidence-informed policy approaches.

Trauma Care doi: 10.3390/traumacare6020009

Authors: Emilie E. Vomhof-DeKrey Olayinka David Ajayi

Background: The management of persistent post-concussive symptoms (PPCS) is limited by the absence of objective biomarkers to guide treatment. We examined the early effects of a mild hyperbaric oxygen protocol on serum biomarkers of neuronal injury (neurofilament light chain, NfL), astrogliosis (glial fibrillary acidic protein, GFAP), acute neuronal injury (ubiquitin C-terminal hydrolase L1, UCH-L1), and axonal stability (total tau) in patients with PPCS. Methods: In this single-center, randomized, placebo-controlled trial, we enrolled adults with PPCS lasting from 3 months to 5 years after mild traumatic brain injury. Participants received 40 sessions of either active treatment (≥99% O2 at 1.5 atmospheres absolute, ATA) or a true chamber placebo (21% O2 with simulated pressure changes). Serum samples were collected at baseline and 13 weeks after treatment. The primary outcome was the difference between groups in serum NfL levels. Analysis was performed on an intention-to-treat basis using a two-way ANOVA with Šídák’s multiple comparison test. Findings: Of 84 individuals assessed, 20 were randomized (Placebo, n = 9; Intervention, n = 11). Eight from each group received their respective interventions. At 13 weeks, one participant from each group was lost to follow-up, leaving seven per group for analysis. We found no significant differences in serum levels of GFAP, NfL, total tau, or UCH-L1 between the intervention and placebo groups from baseline to 13 weeks. Conclusions: A 40-session mild hyperbaric oxygen protocol at 1.5 ATA did not significantly change serum biomarkers of neuronal injury, astrogliosis, or acute neuronal damage at 13 weeks post-treatment in individuals with PPCS. This early-phase analysis, at the highest point of participant retention, provides no evidence of a treatment effect on these pathophysiological markers.

Trauma Care doi: 10.3390/traumacare6020008

Authors: Bianca Lai Georgia Lockett Aislinn Lalor Christina Ekegren Mitchell Sarkies Sandra Reeder Prue Morgan Belinda Gabbe Carol Hodgson

Background/Objectives: Traumatic injury in adults can result in decreased physical function, reduced health-related quality of life, and persisting mental health problems. Enhanced rehabilitation in the acute setting may support recovery. Although prior reviews have investigated enhanced rehabilitation across multiple care settings, there remains limited emphasis on interventions implemented specifically within the acute phase of care. This narrative review aimed to examine the current evidence evaluating the effect of enhanced rehabilitation delivered by physiotherapy and/or occupational therapy on physical function following traumatic injury. Methods: A systematic search of Ovid MEDLINE, Embase, and CINAHL was conducted to identify experimental and quasi-experimental studies that delivered enhanced unidisciplinary or multidisciplinary rehabilitation immediately following traumatic injury. Key findings from relevant studies were synthesised narratively. Results: Three randomised controlled trials were included. Due to heterogeneity in population presentations, interventions, outcomes, and timing of measurement, qualitative synthesis was not feasible. There was no significant difference in acute length of stay or discharge destination between intervention and control groups. The effect of enhanced rehabilitation on physical function was inconclusive, and the optimal dosage remains unclear due to inadequate reporting. Conclusions: Evidence for enhanced rehabilitation after traumatic injury is limited. Further research is needed to determine the effect of enhanced rehabilitation on physical function in this population. Pragmatic study designs with standardised reporting and patient-centred outcome measures to capture traumatic injury populations are needed to improve synthesis of findings and guide clinical practice.

Trauma Care doi: 10.3390/traumacare6020007

Authors: Joanna S. Cohen Priyal Patel Katherine Hoops Amie Bettencourt Leticia Manning Ryan

Background: Firearm injuries are the leading cause of mortality among youth in the United States and legislation is a key strategy in reducing youth firearm injuries and deaths. Maryland recently enacted a stronger child access prevention (CAP) law known as Jaelynn’s Law, which mandates secure firearm storage and imposes stricter penalties for violations. Objectives: The aim of this study was to examine firearm storage practices and beliefs in a pediatric and adult emergency department in Baltimore before and after the implementation of Jaelynn’s Law. Method: This descriptive study recruited 396 adult participants from pediatric and adult EDs at Johns Hopkins Hospital before and after the implementation of Jaelynn’s Law. Participants completed a survey on demographics, firearm ownership, and storage practices. Those with unsafe storage practices were provided educational pamphlets and safe storage devices. Data were analyzed using SPSS Statistics 28, with descriptive statistics, t-tests, and Chi-square analyses used to assess differences pre- and post-law implementation. Results: Of the participants, 29% owned firearms, with 86% of firearm owners having children in the home. Firearms were primarily stored locked and unloaded. No significant differences in storage practices were observed after implementation of Jaelynn’s Law. Participants cited quick access for personal protection as a key barrier to safe storage. Conclusions: We found no significant change in safe storage practices post-implementation of Jaelynn’s Law. Concerns about personal safety continue to be of primary concern and public health campaigns, legislative measures, and community investment are necessary to enhance safety and safe storage compliance.

Trauma Care doi: 10.3390/traumacare6010006

Authors: Asher Ralphs Constana Gracia Devesh Sarda Subhajit Chakrabarty Navdeep Samra Bharat Guthikonda Deepak Kumbhare Julie Schwertfeger

Background/Objectives: Traumatic brain injury (TBI) affects more than 50 million people annually worldwide. Challenges in managing moderate-to-severe TBI include high rates of hospital-acquired infections and substantial variability in discharge disposition, and these combined challenges contribute significantly to the cost and trajectory of health recovery. Although current strategies such as antibiotic-impregnated external ventricular drains (EVDs) offer some benefit in controlling infections, they remain limited by high cost and inconsistent implementation. A clearer understanding of clinical and demographic factors associated with infection risk and discharge disposition are essential for improving care pathways. This study aims to identify and quantify key determinants of infection and discharge outcomes in patients with TBI. Methods: The National Trauma Database (NTDB) was queried using structured query language (SQL) based on predefined inclusion criteria (adult patients with ICD-coded TBI), input variables (basic demographics, injury location and severity, and vital signs), and specified outcome variables (emergency department discharge disposition, infection, and sepsis) to identify and filter the eligible patient cohort. A set of machine learning models were trained for each outcome (e.g., Emergency Department (ED) discharge, types of infections, and sepsis). Results: Data from 310,494 patients were extracted. The prediction model we developed, the Predictive TBI-Disposition Model (PTDM), was able to predict the outcome of a patient’s discharge with 96% accuracy. The accuracy of the models for infection and sepsis was 93% and 94%, respectively. Conclusions: Demographic and clinical factors significantly influence the discharge disposition and infection risk among TBI patients. Machine learning models demonstrated strong predictive performance, suggesting their utility in early risk stratification and targeted clinical decision-making.

Trauma Care doi: 10.3390/traumacare6010005

Authors: Denise Baloi Clayton Rawson Deondra Montgomery Michael Karsy Mehrdad Pahlevani

Introduction: Severe traumatic brain injury (sTBI) frequently coexists with polytrauma and often necessitates damage control neurosurgery (DCNS), where rapid decompression and temporary stabilization take precedence over definitive reconstruction. Within this context, anesthetic management must balance cerebral protection with ongoing resuscitation, yet high-quality DCNS-specific evidence remains limited. Materials and Methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2015–2025) was conducted using MeSH terms and keywords related to neurotrauma, anesthesia, intracranial pressure, and perioperative management. Studies were included if they examined anesthetic or hemodynamic strategies in severe TBI or DCNS and reported relevant clinical or physiologic outcomes. Results: Nineteen articles addressing perioperative strategies for optimizing DCNS outcomes were analyzed. Discussion: Preoperative care emphasizes hemodynamic stabilization and permissive hypertension, damage control resuscitation including massive transfusion protocols, optimization of cerebral perfusion pressure (CPP) and neuromonitoring, and the use of hyperosmolar therapy. Transexamic acid can be used in sTBI safely but with unclear improvement in outcomes. Intraoperatively, propofol-based total intravenous anesthesia is generally preferred over volatile agents due to favorable effects on intracranial pressure (ICP), cerebral blood flow (CBF), autoregulation, and emergence. While historically contraindicated, ketamine and etomidate are now increasingly used as hemodynamically protective induction agents. Analgesic and sedative strategies prioritize dexmedetomidine and carefully titrated opioids to minimize respiratory depression and reduce postoperative complications. CPP and ICP-directed management relies on individualized blood pressure targets, vasopressor selection, lung-protective ventilation, and strict temperature control. Conclusions: Emerging evidence has suggested the benefit of DCNS for patient survival. Overall, perioperative care is guided largely by physiology and extrapolation, highlighting the need for standardized protocols.

Trauma Care doi: 10.3390/traumacare6010004

Authors: Teleale Fikru Gebeyehu Michael Vo Adam Leibold Shaan Patel Jack Jallo Alexander R. Vaccaro James S. Harrop

Background/Objectives: In the past few decades, there have been advancements in surgical techniques, improved understanding of spinal biomechanics, and awareness of complications associated with halo vest (HV) use with resultant surgical treatment of various pathologies that cause acute or chronic atlantoaxial instability. The purpose of this study was to see how HV usage has changed over time. Methods: A retrospective analysis of the North American Clinical Trials Network database. Patients with cervical spinal cord injury from 2006 through 2019 were identified and the trend of HV use was analyzed. Results: The mean age of patients who received HV was 37.4 years and 50 for those treated with other options, p < 0.0001. Its use consistently declined after 2009. After 2015 this decline reached nil in the database (p < 0.0001). Patients between 45 and 59 years (3.4%) and Above 60 years (2.8%) group had the least treatment using HV. Fall accident (4.7%, p = 0.0295) and central cord syndrome (4.6%, p = 0.0004) were associated with low HV use. Pulmonary complications were higher (89.4%) with HV use (vs. 65.9% with no HV), p = 0.0008. Pulmonary complications with HV decreased after 2012. Conclusions: HV as treatment option for conditions involving the cervical spine has decreased. This declining trend is attributable to decreased use in older individuals due to higher rates of complications and unfavorable outcomes with its use. The decreasing trend appears to coincide with published data showing better outcomes with surgical treatment and unfavorable outcomes with HV use.

Trauma Care doi: 10.3390/traumacare6010003

Authors: Zoe Kee Hui Wong Tesfaye S. Mengistu Eamon Raith Neale Thornton Matthew Hiskens

Background/Objectives: Traumatic brain injury in elderly patients is a significant public health concern, particularly for those on antithrombotic therapy. A clearer understanding of how different antithrombotic agents affect the likelihood of intracranial hemorrhage in elderly patients with TBI is needed to guide clinical management. Therefore, the objective of this study was to assess the effect of preinjury antithrombotic agents on the incidence of intracranial hemorrhage in elderly patients with traumatic brain injury. Methods: The design was a retrospective cohort study set in a regional Australian hospital emergency department. The study evaluated elderly patients (≥65 years) with head injury cases identified from the integrated electronic medical record using SNOMED codes. Data on patient demographics, antithrombotic use, computed tomography imaging, and outcomes were collected. Results: A total of 152 elderly TBI patients were included in the study. Of these patients, 90.1% had falls leading to TBI. Among the patients, 30.3% were on antiplatelet agents, 23% were on direct oral anticoagulants, 7.2% were on vitamin K antagonists, and 39.5% were not on any antithrombotic agents. Intracranial hemorrhage was found in 26.5% of patients, with both direct oral anticoagulants (aOR 4.87, 95% CI 1.42–16.67, p < 0.01) and vitamin K antagonists (aOR 4.95, 95% CI 1.04–23.55, p < 0.04) demonstrating statistically significant associations with increased odds of ICH. Conclusions: Both vitamin K antagonists and direct oral anticoagulants were associated with a higher odds of intracranial hemorrhage in elderly patients with TBI, while antiplatelet therapy did not show this effect.

Trauma Care doi: 10.3390/traumacare6010002

Authors: Luis Teba-del-Pino Luis Suárez-Arrones Eduardo Sáez de Villarreal

Goring during bullfights represents a penetrating trauma with a high risk of muscular, vascular, and vital injuries. Despite its frequency and severity, limited information is available on the immediate physiological response of the bullfighter at the moment of trauma. This case report describes the heart rate of a professional bullfighter who was gored during a bullfight, underwent surgery, and returned to fight the next bull. During the first fight, the bullfighter suffered a penetrating goring wound to the inner side of the lower third of his right thigh and a fracture of the ninth rib with intercostal rupture. Upon standing, he experienced a marked drop in heart rate and a feeling of loss of consciousness, possibly associated with vasovagal presyncope. He was transferred to the infirmary in hemodynamically stable condition. He was given local anesthesia, followed by surgical exploration, cleaning, and layered closure of the wound. After surgery, the bullfighter experienced a gradual increase in heart rate upon standing, possibly due to postural changes and postoperative sympathetic activation. He then returned to the bullring to resume activity. This case report highlights a possible vasovagal response to penetrating trauma, which may be relevant for trauma care, as a vasovagal or parasympathetic-predominant autonomic response could influence early clinical assessment.

Trauma Care doi: 10.3390/traumacare6010001

Authors: Arsh N. Patel Briana M. Pompa-Hogan Tori N. Kinamon Arsalaan Sayyed Natalia A. Pluta James K. Aden Taylor J. Bates

Background: To compare the biomechanical strength of three fixation techniques for the elbow anterior capsule and coronoid process using a synthetic ulna model. We hypothesize that a cortical suture button would be equivalent to the bone tunnel model but inferior to a screw-post construct. Methods: A biomechanical study was conducted using a composite ulna bone model to simulate coronoid process fixation with three techniques: traditional trans-osseous bone tunnel repair, suspensory fixation using a cortical button, and a screw-post construct using a 3.5 mm cortical screw. All constructs were assembled using high-strength suture. Each specimen underwent axial loading on an Instron machine until failure, defined as loss of fixation through the dorsal cortex. Peak ultimate strength was recorded. Statistical analysis was performed using one-way ANOVA and Tukey’s HSD test. Results: The suture button construct demonstrated the highest mean ultimate strength at 490.3 ± 125.2 N, significantly greater than both the bone tunnel (328.8 ± 86.4 N, p < 0.01) and screw-post constructs (273.4 ± 54.5 N, p < 0.001). While the bone tunnel construct exhibited a 20.3% higher strength than the screw-post construct, this difference was not statistically significant (p = 0.13). The screw-post construct showed the least variability in strength to failure but the lowest overall strength. The suture button demonstrated the greatest mechanical strength but also the most variability. Conclusions: Suspensory fixation using a titanium cortical suture button provides significantly greater mechanical strength compared to traditional bone tunnel and screw-post techniques in a synthetic ulna model. While variability was greatest with the suture button construct, its superior load-bearing capacity suggests potential advantages in stabilizing the elbow through anterior capsule and coronoid fracture repair. These findings support further clinical investigation of suture button fixation as a viable technique in complex elbow injuries.

Trauma Care doi: 10.3390/traumacare5040029

Authors: Stephanie H. Vu Brandon J. De Ruiter Samantha J. King Jeffrey B. Friedrich Christopher S. Crowe Yusha Katie Liu

Background/Objectives: Early diagnosis and surgical intervention are critical in upper extremity (UE) compartment syndrome to prevent irreversible muscle necrosis or amputation. Despite its prevalence, there remains limited literature guiding surgical management or predictors of complications. This study aims to characterize risk factors and outcomes following UE fasciotomies. Methods: A 14-year (2010–2024) retrospective review was conducted of adult patients undergoing fasciotomies for UE compartment syndrome at a level 1 trauma center. Exclusion criteria included age <18 years, incomplete records, or fasciotomies not performed for compartment syndrome. Data collected include demographics, injury mechanism, presenting symptoms, and diagnostic methods. Intraoperative details obtained include incision type, number of interventions, closure method, presence of muscle necrosis, and amputation. Results: Fifty-five patients (58 extremities) met the inclusion criteria (median age 42 years; 85% male). Mechanisms included fractures (29.3%), prolonged pressure (“found-down”) (25.9%), vascular injuries (13.8%), ballistic trauma (8.6%), crush (6.9%), and other (15.5%). Common symptoms were pain (72.4%), paresthesias (48.3%), and motor dysfunction (43.1%). Isolated fasciotomy incisions included volar forearm (41.4%), hand (8.6%), dorsal forearm (3.4%), and upper arm (1.7%), with the remaining being combinations thereof. Among the 40 total volar forearm fasciotomies, none developed postoperative dorsal forearm muscle necrosis. Muscle necrosis (19%) was associated with pallor (p = 0.05) and pulselessness (p < 0.001). A prolonged pressure mechanism was associated with increased muscle necrosis (p = 0.02) and amputation (p < 0.001). Meanwhile, the fracture mechanism was associated with decreased muscle necrosis (p < 0.001) and higher DPC rates (p < 0.001). Conclusions: Pain, paresthesias, and motor dysfunction were most common symptoms in UE compartment syndrome; pallor and pulselessness correlated with muscle necrosis, indicating advanced compartment syndrome. The prolonged pressure mechanism was associated with greater muscle necrosis and amputation, while fracture-related mechanisms were associated with decreased muscle necrosis and higher DPC rates.

Trauma Care doi: 10.3390/traumacare5040028

Authors: Meghana V. Nair Ekrem M. Ayhan Bohdanna Zazulak Cara Tomaso Michael J. Medvecky

External fixation is widely used in trauma care for managing bone and soft tissue injuries. These devices are often associated with psychological challenges and are often not followed up with sufficient psychological support for the patient. The specific psychological impact of external fixation following traumatic injuries remains underexplored. This scoping review aimed to synthesize the current literature on the psychological impact of external fixation in trauma patients. A systematic search of CINAHL, Cochrane Library, PsycInfo, PubMed, Scopus, Google Scholar, and EBSCO identified ten studies (2006–2024), from the USA, Europe, Asia, and Oceania to be included based on inclusion criteria of using the device for traumatic injuries (excluding limb lengthening procedures) and assessing psychological outcomes using validated tools. Data extracted included injury type, fixator application, survey type, and mental health outcomes. Common measures included HADS, SF-36/SF-12, PedsQL, CRIES-13, EQ-5D-5L, and patient-reported questionnaires. The findings showed that elevated psychological distress was greatest during early recovery (~1 month). Body image concerns were frequently reported with the fixator in place; however, partial recovery of mental health scores was seen by 12–24 months. These findings emphasize the need for additional research and a greater integration of mental health resources in trauma care protocols involving external fixation.

Trauma Care doi: 10.3390/traumacare5040027

Authors: Andrea Munoz Jennifer Lai-Trzebiatowski Tyler Smith Nikki N. Frousakis An-Fu Hsiao Seth D. Norrholm Chelsea Aden Teresa Calloway Megan Jung Kala Carrick Ruth Alpert Anastasia Krajec Tanja Jovanovic Michael Hollifield

Background: Quality of life is a foundational component of overall health and is negatively impacted by post-traumatic stress disorder (PTSD). In the last decade, acupuncture treatment has become a popularized treatment option for PTSD, especially for Veterans. Research evidence is needed to provide support for acupuncture as a treatment for PTSD which leads to an enhanced quality of life. Objectives: This paper investigated the changes in health-related quality of life in Veterans with combat PTSD who enrolled in a 5-year randomized (two-arm, parallel-group, prospective, single-blinded) clinical trial, completing either a control (Sham) or acupuncture (Verum) treatment (N = 93). Methods: Health-related quality of life was measured by the Veterans RAND 12-item Health Survey (VR-12). Paired t tests between and among participants’ differences were calculated for the Verum acupuncture group, Sham acupuncture group, and Total group. Results: Veterans who completed acupuncture treatment in either randomized arm (Verum and Sham) had a self-perceived improvement in quality of life when assessing physical and mental health symptoms. Specifically, those who were randomized and completed Verum acupuncture treatment reported the greatest improvement in mental health quality of life. Conclusions: Study results support prior foundational findings that acupuncture has a positive effect on self-reported quality of life by reducing PTSD symptoms in Veterans with combat PTSD, with Verum acupuncture eliciting the greatest improvement on mental health symptoms.

Trauma Care doi: 10.3390/traumacare5040026

Authors: Muhammad Imran Aumeerally

Aim: This study aims to assess the relationship between the time-to-CT and outcomes in trauma patients presenting to a regional Australian hospital. Method: This study is a retrospective analysis of prospectively collected data to review the relationship between time-to-CT and the outcomes of mortality, length of stay, and intrahospital transfer for trauma patients presenting to a single regional Australian hospital between January 2000 and July 2022. Results: There were 127 trauma patients who met the inclusion criteria during the study period. Comparing patients who had a CT performed within 1 h of arrival to patients those who had a CT performed more than 1 h after arrival, there was no statistically significant difference in mortality rate (8.0% vs. 7.7%, p = 1.000), and no statistically significant difference in length of stay (4.5 days vs. 3 days, p = 0.496). Increased age was associated with an increased risk of mortality while First Nations people were found to have a shorter length of stay within hospital. Conclusions: In this cohort study, the time-to-CT was not predictive of increased mortality risk in trauma patients presenting to a regional hospital. The time-to-CT in this regional hospital was comparable to published data from level I trauma centres in Australia. What does this paper add to the literature? This paper is the first to look at the impact of time-to-CT in the regional Australian setting.

Trauma Care doi: 10.3390/traumacare5040025

Authors: Estelle Laney Shumani Makhadi Ekene Emmanuel Nweke Nnenna Elebo Maeyane Stephens Moeng

Background: Fractured ribs remain a significant cause of morbidity and are associated with severe injuries requiring several healthcare resources and may be associated with prolonged hospital stays that may require an ICU facility. In our facility, we have a high burden of patients sustaining rib fractures, and we aim to compare management options, outcomes, and factors associated with mortality from a single center. Methods: A retrospective review was performed on patients who presented with rib fractures at a Level 1 Trauma facility in Johannesburg, undergoing medical or surgical management. The study included data from 1 July 2011 until 31 December 2020. All patients were identified using the Medibank database. STATA Version 18 software was used for all data analysis. A p-value of <0.05 was considered statistically significant. Injuries were subdivided according to the Abbreviated Injury Severity score as follows, Mild = AIS Grade I–II, Moderate = AIS Grade III, Severe AIS Grade IV–V. Results: There was a total of 940 patients. The median age was 45 (IQR: 34–55) years, with 22% female patients in a cohort of 940. The mechanism of injury was blunt in 96%. Most patients (93%) fractured 3/> ribs. Only 4.6% sustained a flail chest. The median SBP was 126 mmHg (IQR:109–144), and the pulse rate was 91 (IQR: 79–108) beats per minute. The mean Injury Severity Score (ISS) and New Injury Severity Score (NISS) were 17 (IQR: 10–29) and 22 (IQR: 14–34), respectively. The most common associated injuries were chest trauma in 42%, combined abdominal and pelvic trauma in 35%, and severe extremity trauma in 37%. The mortality rate was 17% (159/940). Most patients required medical and supportive management, with only 8% undergoing rib plating (76/940). The mean length of stay was 14 days (IQR: 6–25). Statistically significant factors associated with mortality were rib fractures 3≥, flail chest, higher ISS, severe head, neck, chest, abdomen and pelvis injuries (p-value 0.001) and severe extremity injury (p-value 0.006). Conclusions: Rib fractures remain a common pathology in the trauma population, and these patients can have significant associated injuries. With an appropriate multidisciplinary approach, our study found an 83% survival rate, and only 8% of patients requiring surgical intervention. Poor outcomes in patients are directly linked to the number of ribs involved, the injury severity score, associated injuries, and advanced age.

Trauma Care doi: 10.3390/traumacare5040024

Authors: Coeway Boulder Thng Jeremy Mingfa Sun

Post-traumatic lymphedema (PTL) is a chronic and often under-recognized sequela of soft tissue trauma, leading to persistent swelling, functional impairment, and increased risk of infection. While lymphedema is traditionally associated with oncologic interventions, growing evidence highlights the significant burden of PTL in trauma patients. This review provides a comprehensive analysis of the current understanding of PTL, including epidemiology, risk factors, pathophysiology, diagnostic modalities, and treatment strategies. PTL often occurs after high-impact musculoskeletal injuries (such as open fractures with significant soft tissue loss) or burns (especially if deep or circumferential). This risk is increased if injury occurs at critical areas of increased lymphatic density (such as anteromedial leg, medial knee, medial thigh, medial elbow, or medial arm). Advances in imaging techniques, including indocyanine green lymphography and magnetic resonance lymphangiography, have improved early detection and classification of PTL. Management approaches range from conservative therapies, such as complete decongestive therapy (CDT), to surgical interventions, including lymphaticovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and vascularized lymph vessel transfer (VLVT)/lymph-interpositional-flap transfer (LIFT). We report on our experience with two patients. At our center, we diagnose and stage PTL with ICG lymphography and trial CDT for 6 months. If there is no significant improvement, we recommend LVA. If there is insufficient improvement after 12 months, we recommend LIFT/repeat LVA/VLNT. We also treat open fractures with significant soft tissue defects with LIFT, as prophylaxis against PTL. PTL remains an underdiagnosed condition, necessitating increased awareness and intervention to prevent long-term disability.

Trauma Care doi: 10.3390/traumacare5040023

Authors: Narinder Kumar Joanna F. Dipnall Belinda Gabbe Richard S. Page Ilana N. Ackerman

Objective: There is scarce reporting of radial head fracture epidemiology and patient characteristics beyond age and sex. This study aimed to describe demographic, socioeconomic, and injury pattern characteristics for people sustaining a radial head fracture admitted to trauma centers over a 15-year period. Methods: Analysis of Victorian Orthopaedic Trauma Outcomes Registry data was conducted to describe the demographic and case characteristics of patients with radial head fractures admitted to collaborating hospitals. Cohort and case characteristics were compared by center type (Level 1 vs. other trauma centers). Results: A total of 991 cases with a unilateral radial head fracture were recorded over 15 years, with 827 admitted to Level 1 trauma centers and 164 admitted to other centers. The mean age at time of injury was 48.7 years (SD 19.7), with male predominance (n = 621, 62.7%). Most patients resided in major cities (n = 824, 85.2%), were treated under the universal healthcare system (n = 546, 56.1%), and had no Charlson Comorbidity Index conditions (n = 738, 74.5%). A higher proportion of patients managed at Level 1 centers were male (65.7% vs. 47.6%), younger (mean 47.7 vs. 53.7 years), living in major cities (86.6% vs. 78.5%), and working prior to injury (71.3% vs. 57.1%). Over 85% of the cohort sustained concomitant injuries, with Level 1 centers receiving a higher proportion of multiple injury cases (87.8% vs. 73.2%). Elbow dislocations constituted the largest proportion of concomitant injuries (n = 257, 25.9%). Conclusions: This study has provided new insights into the demographic characteristics, comorbidity status, and associated injuries of radial head fracture populations admitted to Level 1 and other trauma centers, using long-established registry data.

Trauma Care doi: 10.3390/traumacare5030022

Authors: Erin M. Scott Byron Y. Chen Ahmed Sobieh Jon D. Dorfman Hao S. Lo

Background: In recent years, endovascular repair has outpaced open repair of blunt traumatic aortic injury (TAI), calling for updated evaluation of severity grading systems to ensure continued efficacy in guiding clinical decision-making. Methods: A retrospective review assessed all adult presentations of blunt thoracic TAI to a single institution from 2005 through 2018. Associations of severity grade with demographics, presentation variables, intervention, and outcomes were analyzed. Results: Thirty-eight patients were included in the analysis. Repair (all endovascular) was pursued in 20 (53%) patients. By grade, 0% of grade 1, 20% of grade 2, 82% of grade 3, and 0% of grade 4 injuries were repaired. Hospital mortality was 16%, and median hospital length of stay was 18 days (IQR 9, 28). Conclusions: A uniform four-grade severity grading system continues to be useful in guiding clinical management for TAI in an environment that is increasingly utilizing endovascular repair.

Trauma Care doi: 10.3390/traumacare5030021

Authors: Laura Zima Delani Woods Silin Wu Xuefang Sophie Ren Ryan Kitagawa

Objective: Traumatic anterior skull base fractures can be associated with significant morbidity and are managed based on the method of injury, presence of cerebrospinal leak, clinical stability and other factors. Our objective is to determine factors associated with the development of infection in the management of surgical anterior skull base fractures. Methods: We completed a retrospective review of adult patients with traumatic anterior skull base fractures treated operatively with bi-frontal craniotomy from 2012 to 2022. The statistical analysis was completed with Prism 9.0 software for spearman correlation coefficient analysis. Results: Our study had a total of 51 patients. The average time from arrival to surgery was four days. A total of 20 patients were injured via gunshot wound (GSW) and 31 via other methods of injury. A total of 81% of patients were started on antibiotics prior to surgery, and all patients were kept on antibiotics after surgery. Five patients developed infections. Infection was not correlated with time to surgery, length of stay, type/duration of antibiotics, EVD placement/duration, or lumbar drain placement. However, all but one of the infections were in patients injured by GSWs vs. other mechanisms of injury (p < 0.01), and duration, not merely presence, of lumbar drain was correlated with development of infection (p < 0.01). Conclusions: In the treatment of anterior skull base fractures, time to surgery does not significantly increase risk of infection. However, patients with gunshot wounds have higher risks of infection, and thus more aggressive management should be considered.

Trauma Care doi: 10.3390/traumacare5030020

Authors: Rudo Mutsa Vanessa Pswarayi Adelin Muganza Phineas Denzel Mogabe

Background: Trauma injury scoring systems are essential for standardized assessment, treatment decisions, and outcome prediction in trauma patients. The mechanism, Glasgow Coma Scale (GCS), age, and arterial pressure (MGAP) score offers a simplified approach that is particularly beneficial in resource-limited settings. This study aims to determine the association between the MGAP scoring system and mortality outcomes in trauma patients presenting to the trauma emergency unit (TEU) in a resource-limited setting. Objective: To determine the association between the MGAP scoring system and mortality outcomes in trauma patients presenting to the trauma emergency unit (TEU) in a resource-limited setting. Methods: A retrospective record review was conducted on priority 1 (P1) trauma patients aged 18 years or older who presented to the TEU of a hospital between 1 January 2022 and 31 December 2022. Data extracted from the TEU resuscitation register included age, sex, mechanism of injury, blood pressure (BP), and Glasgow Coma Scale (GCS). The primary outcome was survival versus death. MGAP scores were calculated, and statistical analyses were performed to assess the association between MGAP scores and mortality. Results: A total of 1220 patients were included in this study. The analysis revealed a statistically significant association between MGAP scores and mortality (p < 0.0001). Lower MGAP scores were associated with higher mortality rates. Specifically, patients with MGAP scores ≤ 18 had a mortality rate of 48.1%, while those with scores between 19 and 22 had a mortality rate of 23.5%. The mortality rate was 2.2% for MGAP scores between 23 and 29, and 0% for scores ≥ 30. GCS score and systolic blood pressure were also significantly associated with mortality (p < 0.0001 and p < 0.05, respectively), while the mechanism of injury was not significantly associated with mortality. Conclusions: The MGAP score is a valuable tool for risk stratification in trauma patients in resource-constrained settings, demonstrating a strong inverse correlation with mortality outcomes. Its simplicity and reliance on readily available parameters make it particularly useful for rapid triage and resource allocation in LMICs. These findings support the implementation of the MGAP score in trauma triage protocols and highlight the need for further research to validate its performance in diverse LMIC settings and explore its potential for integration into national trauma care guidelines.

Trauma Care doi: 10.3390/traumacare5030019

Authors: Juan F. Figueroa Susana Fortich

Background: Rib fractures are among the most common thoracic injuries following blunt trauma and are associated with significant morbidity, particularly in elderly and polytrauma populations. Historically managed non-operatively, recent advances have redefined the role of surgical stabilization of rib fractures (SSRF) in improving patient outcomes. The objective of this narrative review is to evaluate current evidence surrounding the management of rib fractures, with a focus on indications for SSRF, surgical techniques, special populations, and future directions in care. Methods: A narrative review of the literature was conducted, incorporating relevant randomized controlled trials, cohort studies, clinical guidelines, and expert consensus statements. Emphasis was placed on patient selection criteria, surgical strategies, multimodal analgesia, and emerging technologies. Results: SSRF has demonstrated benefits in short- and long-term outcomes, including improved pain control, reduced ventilator dependence, shorter ICU and hospital stays, and better functional recovery. These outcomes are most evident in patients with flail chest, severe displacement, or failure of conservative therapy. Minimally invasive techniques and 3D-printed implants represent promising innovations. Despite growing evidence, SSRF remains underutilized due to variability in institutional protocols and access to trained personnel. Conclusions: The management of rib fractures continues to evolve with increasing support for surgical intervention in select patients. Wider implementation of SSRF, guided by standardized protocols and advanced technologies, may improve outcomes and reduce complications in this high-risk trauma population.

Trauma Care doi: 10.3390/traumacare5030018

Authors: Robert Lundblad Saul Jaeger Jennifer Moreno Charles Silber Matthew Rensi Cass Dykeman

Background/Objectives: This study examines the academic discourse surrounding Critical Incident Stress Debriefing (CISD) and Critical Incident Stress Management (CISM) for first responders using Latent Dirichlet Allocation (LDA) topic modeling. It aims to uncover latent topical structures in the literature and critically evaluate assumptions to identify gaps and limitations. Methods: A corpus of 214 research article abstracts related to CISD/M was gathered from the Web of Science Core Collection. After preprocessing, we used Orange Data Mining software’s LDA tool to analyze the corpus. We tested models ranging from 2 to 10 topics. To guide interpretation and labeling, we evaluated them using log perplexity, topic coherence, and LDAvis visualizations. A four-topic model offered the best balance of detail and interpretability. Results: Four topics emerged: (1) Critical Incident Stress Management in medical and emergency settings, (2) psychological and group-based interventions for PTSD and trauma, (3) peer support and experiences of emergency and military personnel, and (4) mental health interventions for first responders. Key gaps included limited focus on cumulative trauma, insufficient longitudinal research, and variability in procedural adherence affecting outcomes. Conclusions: The findings highlight the need for CISD/M protocols to move beyond event-specific interventions and address cumulative stressors. Recommendations include incorporating holistic, proactive mental health strategies and conducting longitudinal studies to evaluate long-term effectiveness. These insights can help refine CISD/M approaches and enhance their impact on first responders working in high-stress environments.

Trauma Care doi: 10.3390/traumacare5030017

Authors: Jessica Falon Krishna Kotecha Wafa Araz Mokari Anubhav Mittal Jaswinder Samra

This case report describes index pancreatoduodenectomy in a 32-year-old male following a close-range gunshot wound to the abdomen, with consequent 4 cm pancreatic head defect, duodenal and common bile duct perforation, right kidney laceration, and through-and-through inferior vena cava (IVC) injury. Although standard trauma protocols often favor damage control surgery (DCS) with delayed reconstruction in unstable patients, this patient’s hemodynamic stability—attributed to retroperitoneal self-tamponade—enabled a single-stage definitive approach. The rationale for immediate reconstruction was to prevent the risks associated with delayed management, such as ongoing pancreatic and biliary leakage, chemical peritonitis, and subsequent sepsis or hemorrhage. This case highlights that, in select stable patients with severe pancreaticoduodenal trauma, immediate pancreatoduodenectomy may be preferable to DCS, provided care is delivered in a high-volume hepatopancreaticobiliary (HPB) center with appropriate expertise and resources.

Trauma Care doi: 10.3390/traumacare5030016

Authors: Isabella Margaretha Joubert Zoé Otto Nnenna Elebo Maeyane Stephens Moeng

Background: Liver trauma is prevalent following blunt and penetrating injuries. This study examined liver trauma in a South African urban trauma centre, focusing on the unique prevalence of penetrating injuries and surgical interventions. Methods: A retrospective analysis was conducted of 512 priority-one patients with liver trauma from January 2017 to December 2023 at Charlotte Maxeke Johannesburg Academic Hospital. The data collected included demographics, injury mechanisms, liver injury grades, associated injuries, injury severity scores (ISS and NISS), surgical interventions, and mortality rates. Statistical analyses were performed using Stata (V.18) and R software (version 4.3.2). Results: The median age of the patients was 31 years, with a predominance of male patients (91%) and patients of African ethnicity (95%). Penetrating trauma accounted for 73% of the cases. Most liver injuries were minor (grades I–III). There was a 5% overall mortality rate, with a higher rate observed in patients requiring emergency surgery (10% vs. 1% for non-operative management, p < 0.001). Just over half of the patients required emergency laparotomy, and the majority of these patients sustained penetrating liver trauma. Complications occurred in 6.6% of the patients, predominantly biliary in nature. Conclusions: This study highlights the high incidence of penetrating liver trauma in South Africa, which reflects the context of interpersonal violence. The mortality rate aligns with international standards and demonstrates the need for effective management strategies. These findings emphasise the need for tailored approaches to liver trauma based on injury patterns and demographics, and further research is needed to explore the associated mortality and complications.

Trauma Care doi: 10.3390/traumacare5030015

Authors: Katherine Goodchild Jodie A. Copley Jennifer Fleming

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.

Trauma Care doi: 10.3390/traumacare5020014

Authors: Jocelyn Schwegler Kristin Mauldin Kerri Racin-Anderson Alexandra Hotetz Jaimee Stutz-Johnson Laiyatu Manya Kamonie Davis Melanie Estrada

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.

Trauma Care doi: 10.3390/traumacare5020013

Authors: Rachel C. Bock Jessy L. Thomas BreAnne A. Danzi

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.

Trauma Care doi: 10.3390/traumacare5020012

Authors: Yafa Shani Parnasa Oded Cohen-Arazi Gad Marom Mahmoud Abu-Gazala Noam Shussman Miklosh Bala

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.

Trauma Care doi: 10.3390/traumacare5020011

Authors: Kennedy Nkachukwu Emily R. Arellano Amanda Alejo Anna Cmolik Jeffrey W. Toman Jalal S. Jwayyed Nicholas Ventigan Justin E. Iwuagwu Andrew L. Alejo

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.

Trauma Care doi: 10.3390/traumacare5020010

Authors: Robert Hennings Carolin Fuchs Firas Souleiman Henkelmann Jeanette Ullrich Joseph Spiegl Christian Kleber Annette B. Ahrberg-Spiegl

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.

Trauma Care doi: 10.3390/traumacare5020009

Authors: Zsolt J. Balogh

Trauma Care (ISSN: 2673-866X) published its initial Aims and Scope in July 2020; since then, it has received a large variety of submissions from several disciplines relevant to physical and physiological trauma [...]

Trauma Care doi: 10.3390/traumacare5020008

Authors: Anna Pitt-Francis Andrew R. Stevens Zubair Ahmed Valentina Di Pietro

Andrew R [...]

Trauma Care doi: 10.3390/traumacare5020007

Authors: Alexandra Matte-Landry Annabelle Lemire-Harvey Amélie de Serres-Lafontaine Vanessa Fournier

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.

Trauma Care doi: 10.3390/traumacare5020006

Authors: Dorothy Chin Tamra B. Loeb Muyu Zhang Michele Cooley-Strickland Jennifer V. Pemberton Gail E. Wyatt

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.

Trauma Care doi: 10.3390/traumacare5020005

Authors: Lucas R. Neumaier Joanna F. Dipnall Susan Liew Belinda J. Gabbe

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.

Trauma Care doi: 10.3390/traumacare5010004

Authors: Waganesh A. Zeleke Mengistu Dagnew Yemataw Wondie Tewodros Hailu Courtney Holmes Mekdes Melesse Mekonen Birtukan Taye Eshete Goshu Nenko

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.

Trauma Care doi: 10.3390/traumacare5010003

Authors: Andrea Argueta Yesenia L. Zetino Marcel A. de Dios Norma Olvera Weihua Fan Consuelo Arbona

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.

Trauma Care doi: 10.3390/traumacare5010002

Authors: Shameeke Taylor Tirth Patel Yukti Desai Connor Welsh Eric Legome

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.

Trauma Care doi: 10.3390/traumacare5010001

Authors: Anna Pitt-Francis Andrew Stevens Zubair Ahmed Valentina Di Pietro

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.

Trauma Care doi: 10.3390/traumacare4040026

Authors: Lauren Johnstone Zubair Ahmed

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.

Trauma Care doi: 10.3390/traumacare4040025

Authors: Andrew S. Hyde Carlos E. Brown

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.

Trauma Care doi: 10.3390/traumacare4040024

Authors: Sean Inzerillo Salazar Jones

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.

Trauma Care doi: 10.3390/traumacare4040023

Authors: Oluwaseun Adeyemi Charles DiMaggio Corita Grudzen Sanjit Konda Erin Rogers Saul Blecker JohnRoss Rizzo Joshua Chodosh

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.

Trauma Care doi: 10.3390/traumacare4040022

Authors: Rayyan A. Bukhari Jennifer A. Weaver Julia Sharp Amanda Hoffman Deana Davalos Matt P. Malcolm James E. Graham

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.

Trauma Care doi: 10.3390/traumacare4030021

Authors: Natale Schmitz Katie Aafjes-van Doorn Vera Békés

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.

Trauma Care doi: 10.3390/traumacare4030020

Authors: Tanzi D. Hoover Gerlinde A. S. Metz

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.

Trauma Care doi: 10.3390/traumacare4030019

Authors: Kristi L. Perryman Samantha Robinson Timothy J. Schoonover Julia Conroy

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.

Trauma Care doi: 10.3390/traumacare4030018

Authors: Regina Roberg Tamara Camargo Amy K. Marks

In the original publication [...]

Trauma Care doi: 10.3390/traumacare4030017

Authors: Victor Boya Yang Annabelle Pan Kent Allen Stevens James Earl Harris

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.

Trauma Care doi: 10.3390/traumacare4030016

Authors: Craig R. Miller James E. McDonald Peter P. Grau Chad T. Wetterneck

In the original publication [...]

Trauma Care doi: 10.3390/traumacare4020015

Authors: Charles C. Lin Dhruv S. Shankar Utkarsh Anil Cordelia W. Carter

Background: The purpose of this study was to investigate temporal trends in gunshot wound (GSW)-associated orthopedic injuries among children, adolescents, and young adults in New York State, and to determine the impact of the onset of the COVID-19 pandemic on the incidence of these injuries. Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) inpatient database was reviewed to identify patients ≤ 21 years of age who presented to a hospital with GSW-associated injuries from January 2016 to December 2020. Patient diagnosis codes were cross-referenced with the list of the International Classification of Diseases Version 10 Clinical Modification (ICD-10-CM) codes for orthopedic injuries to determine the incidence of GSW-associated orthopedic injuries among this cohort. The number of cases was cross-referenced with New York State census population estimates to calculate incidence per million. The geographic incidence was plotted over a map of New York State with sub-division based on facility Zone Improvement Plan (ZIP) codes. Poisson regression was used to compare the injury incidence in 2020 (pandemic onset) versus the preceding years (pre-pandemic). Results: Between 2016 and 2020, there were 548 inpatient admissions for GSW-associated orthopedic injuries, representing an incidence of 5.6 cases per million. Injury incidence decreased from 2016 to 2019, with an increase in 2020 representing almost 28% of the total cases identified. There was a statistically significant difference in the incidence rate ratio for 2020 compared to 2016–2019 (p < 0.001). The majority of patients were male (94%), African–American (73%), and covered by either Medicare (49%) or Managed Care (47%). Most cases were clustered around large metropolitan areas with low incidence in suburban and rural regions of the state. Conclusions: There was a two-fold increase in the incidence of GSW-associated orthopedic injuries among patients ≤ 21 years old in New York State during the onset of the COVID-19 pandemic.

Trauma Care doi: 10.3390/traumacare4020014

Authors: Stefan Vasic Bridget Xia Mia E. Dini Daniel W. Klyce Carmen M. Tyler Shannon B. Juengst Victoria Liou-Johnson Kelli G. Talley Kristen Dams-O’Connor Raj G. Kumar Umesh M. Venkatesan Brittany Engelman Paul B. Perrin

Background: Given the aging of the overall U.S. population, the resulting changes in healthcare needs especially among veterans, and the high prevalence of traumatic brain injury (TBI) among older adults, additional research is needed on community participation after TBI in older veterans. The current study examined predictors of community participation trajectories over the 5 years after TBI in veterans who were 55 years of age or older upon injury. Method: This study included data from 185 participants in the U.S. Department of Veterans Affairs TBI Model System national study who had sustained a TBI at age 55 or older and had completed at least one of each Participation Assessment with Recombined Tools-Objective (PART-O) subscale scores at one or more follow-up time points (1, 2, and 5 years post-TBI). Results: PART-O Productivity, Social, and Out and About scores remained constant over time. Lower PART-O Productivity trajectories were seen among participants who were unemployed at the time of injury (p = 0.023). Lower PART-O Social trajectories were seen among participants who had a lower education level (p = 0.021), were unmarried at injury (p < 0.001), and had private insurance coverage (p < 0.033). Conclusion: These findings add to the growing body of literature on TBI and community participation by focusing on an older adult veteran population. There is an urgency to understand the needs of this group, many of whom are aging with service-connected disabilities including TBI. Veterans with characteristics identified herein as being associated with lower community participation trajectories would be prime candidates for interventions that aim to increase community and social engagement after later-life TBI.

Trauma Care doi: 10.3390/traumacare4020013

Authors: Mikael Rubin

Post-traumatic Stress Disorder (PTSD) is a mental health concern impacting a large proportion of the population. There is a growing interest in mindfulness-based treatments for PTSD. However, some individuals with PTSD do not respond to treatment. Identifying factors that may provide a more precise treatment approach has the potential to enhance response. Network analysis is a data-driven methodology that has been used to suggest specific targets for treatment. To date, there has not been a network analysis examining the interrelation between PTSD symptoms and trait mindfulness. The current study is an exploratory analysis of N = 214 adults from a non-clinical sample who endorsed a Criterion A traumatic event and completed the PTSD Checklist for DSM-5 and the Five Facet Mindfulness Questionnaire. Both undirected and directed networks were generated to identify links between PTSD symptom clusters and the facets of mindfulness. Both networks highlighted the connection between the PTSD symptom cluster Alterations in Arousal and Reactivity and the Awareness facet of mindfulness; and the PTSD symptom cluster Negative Alterations in Cognitions and Mood with the Non-judging facet of mindfulness. Taken together, these findings provide further evidence that greater mindfulness is generally associated with lower PTSD symptoms. Importantly, the findings highlight Non-judgement and Awareness as facets that might warrant further investigation in the context of mindfulness-based treatment efforts for PTSD.

Trauma Care doi: 10.3390/traumacare4020012

Authors: Pedro Fuenmayor Gustavo Huaman Karla Maita Kelly Schwemmer Wes Soliman Sahar Abdelmoneim Stephanie Pintos Mark Dickinson Edward Gonzalez Ricardo Castrellon

Background: Skin substitutes play a crucial role in wound care by actively modulating the wound healing process, promoting angiogenesis, and protecting the integrity of the native extracellular matrix. Consequently, surgeons have increasingly recognized these resources as excellent complements to improve reconstructive outcomes. This review focuses on the author’s experience using these biomaterials in complex cases, highlighting the benefits they bring to patient care. Methods: A literature review was conducted to evaluate the regenerative properties of skin substitutes and their applicability in head and neck, upper and lower extremities, and trunk reconstruction. Results: The reviewed literature, along with the authors’ experience, supports the adjunct use of skin substitutes in various reconstructive situations. Combining them with skin grafts improves resulting skin quality and may also enhance donor site healing. They have proven to be effective in addressing chronic venous ulcers, traumatic wounds with limited donor tissues for coverage, extensive burns, diabetic foot ulcers, and oncological resections in the face and scalp. Furthermore, combining them with autologous tissue shows promising results in achieving stable closure. Conclusions: Incorporating skin substitutes in complex reconstructive scenarios offers multiple benefits. Their regenerative properties and ability to modulate the healing process contribute to enhanced outcomes and reduced overall costs.

Trauma Care doi: 10.3390/traumacare4020011

Authors: Connie Oxford

This article is based on exploratory research on how the U.S. Circuit Court of Appeals uses the language of trauma in gender-based asylum claims. Gender-based asylum claims include female genital mutilation (FGM), coercive population control (CPC) in the form of forced abortions and forced sterilizations, rape, forced marriage, and domestic violence. The Circuit Courts have reviewed appeals from petitioners with asylum claims since 1946, yet the language of trauma did not appear in the Court’s decisions until 1983. From 1983 to 2023, only 385, 3.85% or less, of the over 10,000 asylum cases before the Circuit Courts used the language of trauma in its legal interpretation of persecution. I have identified 101 gender-based asylum cases that were reviewed by one of the eleven U.S. Circuit Court of Appeals that apply the language of trauma in its legal interpretation of persecution for this analysis. The research question guiding this study is: how does the U.S. Circuit Court of Appeals use the language of trauma when reviewing gender-based asylum cases? This study found that U.S. Circuit Courts use the language of trauma in four ways: precedent cases, policies and reports, physical trauma, and psychological trauma when reviewing gender-based asylum claims. This study provides the first data set of gender-based asylum claims under review at the U.S. Circuit Court of Appeals that use the language of trauma.

Trauma Care doi: 10.3390/traumacare4020010

Authors: Khang Duy Ricky Le Kelvin Le Abdullah Shahzad Su Jin Lee

(1) Background: Patients who experience acute traumatic injury requiring hospitalisation represent a vulnerable population. The trauma patient often experiences multi-system injuries and complex physiology. Additionally, there are complex socio-ecological issues that impact the care and outcomes of trauma patients. Of interest, culturally and linguistically diverse populations with language barriers experience worse outcomes in trauma settings. This scoping review evaluates the current evidence on language barriers in this population and the influences on outcomes for trauma patients. (2) Methods: A scoping review was performed following a computer-assisted search of the Medline, Embase and Cochrane Central databases. Papers that evaluated the impact of the language barrier in culturally and linguistically diverse populations and outcomes in acute trauma settings were included. (3) Results: A literature search identified eight articles that were eligible for inclusion. Overall, there was no robust evidence to suggest that such populations were disadvantaged in terms of length of hospital stay and overall mortality. However, studies did identify that these populations were at higher risk of disability and poor mental health outcomes, experienced communication barriers more often and had lower social functioning. (4) Conclusions: This scoping review demonstrates that individuals admitted due to trauma who are from culturally and linguistically diverse backgrounds experience more significant disadvantages concerning psychological and functional outcomes. It is posited this is due to their inability to communicate their complex needs in trauma, however more robust and rigorous research is required to better characterise this effect.

Trauma Care doi: 10.3390/traumacare4020009

Authors: Shefali R. Bijwadia Ilexa R. Flagstad Margaret A. Sinkler Samuel T. Davidson Sandy Vang Heather A. Vallier Mai P. Nguyen

Antibiotic prophylaxis for extremity gunshot wounds (GSWs) is highly variable. The objective of the present study is to quantify the adherence rate to a protocol for single-dose cephalosporin prophylaxis for extremity GSWs and the impacts on post-injury infection rates. We reviewed patients presenting to a level 1 trauma center with an extremity gunshot wound between 2019 and 2021. Infection rates were compared for patients following the protocol or not, and for patients presenting before or after the protocol’s implementation. Overall, 94% of patients received antibiotic treatment at presentation, but only 34% followed the single-dose antibiotic protocol. The rate of protocol adherence increased from 15% to 39% after the protocol was implemented in the hospital in January 2020 (p = 0.081). Infection rates were not different before and after the protocol implementation (25% vs. 18%, p = 0.45). Infection rates were also not different between patients who did and did not follow the protocol (15% vs. 20%, p = 0.52). The implementation of a single-dose cephalosporin protocol increased adherence to the protocol in a level 1 trauma center without increasing infection rates. These findings support conservative treatment along with a single dose of first-generation cephalosporin antibiotic for uncomplicated extremity GSWs in order to decrease healthcare costs without compromising infection risk.

Trauma Care doi: 10.3390/traumacare4010008

Authors: Craig R. Miller James E. McDonald Peter P. Grau Chad T. Wetterneck

Posttraumatic stress disorder (PTSD) is associated with functional impairment and poor quality of life (QoL) across multiple domains, such as social functioning, occupational and educational attainment, physical health, and overall life satisfaction and wellbeing. Yet, there is limited evidence for which PTSD symptom clusters may be more strongly associated with functional impairment and decreased QoL. We used a seven-factor model of PTSD (re-experiencing, avoidance, negative alterations, anhedonia, externalizing, dysphoric arousal, and anxious arousal) to predict QoL using a latent regression model in a sample (N = 537) of adult patients participating in exposure-based PTSD partial hospitalization programs (PHP). QoL was measured by the Quality-of-Life Satisfaction Questionnaire—Short Form (Q-LES-Q-SF). Among posttraumatic symptoms, anhedonia emerged as the only significant predictor in the model (β = −8.60, SE = 3.02, p = 0.004), when controlling for depression scores. The overall model accounted for 40% of the variance in QoL. Depression was also significantly associated with QoL (β = −1.67, SE = 0.15, p < 0.001), controlling for PTSD symptoms. Our findings are congruent with prior research supporting the role of anhedonia and emotional numbing in functional impairment, yet differ in that other factors of PTSD (e.g., re-experiencing, avoidance, negative alterations) were not significant. Understanding which PTSD symptom clusters are more strongly associated with QoL may inform treatment approaches or allow clinicians to tailor treatments. We discuss implications for treatment and future research.

Trauma Care doi: 10.3390/traumacare4010007

Authors: Kelly Baek Kimberly R. Freeman Sophia Truong Christi Bell Susanne B. Montgomery

Over 50% of the 21 million veterans in the U.S. with behavioral health challenges are not having their needs met due to stigma and other barriers to care. Resiliency-based models focused on strengthening protective factors to help individuals adapt to adversity in community-based settings, that can be delivered by trained lay persons, are emerging approaches to help address this issue. This longitudinal pilot study evaluated the impact of one such evidenced-based intervention, the Community Resiliency Model (CRM), on veterans’ behavioral health and daily functioning. A sample of 46 English-speaking, ethnically diverse veterans were recruited for this study. Repeated measure analyses showed that CRM skills significantly decreased distress and increased well-being. We also found strong short-term results for measures of daily functioning with a significant longer-term impact on participants’ ability to control their feelings of being ‘amped up’. Most (82%) participants maintained and continued to use the CRM skills daily to weekly and had very positive reactions to the program. Across our analyses, the results of this pilot study suggest that providing CRM trainings to veterans is a feasible, efficacious, and well-received approach to help address much-needed veteran behavioral health.

Trauma Care doi: 10.3390/traumacare4010006

Authors: Regina Roberg Tamara Camargo Amy K. Marks

(1) Background: Immigrant families in the U.S. face a myriad of migration-related stressors and trauma, and legal vulnerability can further compound such stressors, influencing both immigrant caregiver and child wellbeing. This study explored the relationships between legal vulnerability, trauma, and migration and their effects on caregiving, psychological distress, and resilience in immigrant families. (2) Methods: In total, 37 Latinx immigrant caregiver–child dyads from a community sample were interviewed and completed self-report measures on their experiences of migration, trauma, psychological functioning, and parent–child relationships. (3) Results: Using a community-based, sequential quantitative-qualitative design, person-centered analyses revealed two caregiver clusters: “Personalizing Stress” and “Meaning-making”. Exemplar case analyses characterized differences between clusters, particularly related to trauma symptoms, in which the “meaning-making” cluster endorsed higher levels of psychological functioning and wellbeing compared to the “personalizing stress” cluster, in which the process of creating meaning from adversity appeared to function as a resilience resource for the “meaning-making” cluster. While most indicators of caregiver–child wellbeing were not correlated, family legal vulnerability was strongly correlated with high resilience in children. (4) Conclusions: Clinicians should attend to the resilience resources that immigrant families from legally vulnerable communities utilize, including meaning-making.

Trauma Care doi: 10.3390/traumacare4010005

Authors: Yelissa Navarro Elizabeth Huang Chandler Johnson Forrest Clark Samuel Coppola Suraj Modi Gordon L. Warren Jarrod A. Call

The objectives of this study were to determine the effect of COVID-19 on physical therapy (PT) mobilization of trauma patients and to determine if mobilization affected patient course in the ICU. This retrospective study included patients who were admitted to the ICU of a level II trauma center. The patients were divided into two groups, i.e., those admitted before (n = 378) and after (n = 499) 1 April 2020 when Georgia’s COVID-19 shelter-in-place order was mandated. The two groups were contrasted on nominal and ratio variables using Chi-square and Student’s t-tests. A secondary analysis focused specifically on the after-COVID patients examined the extent to which mobilization (n = 328) or lack of mobilization (n = 171) influenced ICU outcomes (e.g., mortality, readmission). The two groups were contrasted on nominal and ratio variables using Chi-square and Student’s t-tests. The after-COVID patients had higher injury severity as a greater proportion was classified as severely injured (i.e., >15 on Injury Severity Score) compared to the before-COVID patients. After-COVID patients also had a greater cumulative number of comorbidities and experienced greater complications in the ICU. Despite this, there was no difference between patients in receiving a PT consultation or days to mobilization. Within the after-COVID cohort, those who were mobilized were older, had greater Glasgow Coma Scale scores, had longer total hospital days, and had a lesser mortality rate, and a higher proportion were female. Despite shifting patient injury attributes post-COVID-19, a communicable disease, mobilization care remained consistent and effective.

Trauma Care doi: 10.3390/traumacare4010004

Authors: Kevin Pierre Jordan Turetsky Abheek Raviprasad Seyedeh Mehrsa Sadat Razavi Michael Mathelier Anjali Patel Brandon Lucke-Wold

In this narrative review, we explore the evolving role of machine learning (ML) in the diagnosis, prognosis, and clinical management of traumatic brain injury (TBI). The increasing prevalence of TBI necessitates advanced techniques for timely and accurate diagnosis, and ML offers promising tools to meet this challenge. Current research predominantly focuses on integrating clinical data, patient demographics, lab results, and imaging findings, but there remains a gap in fully harnessing the potential of image features. While advancements have been made in areas such as subdural hematoma segmentation and prognosis prediction, the translation of these techniques into clinical practice is still in its infancy. This is further compounded by challenges related to data privacy, clinician trust, and the interoperability of various health systems. Despite these hurdles, FDA-approved ML applications for TBI and their subsequent promising results underscore the potential of ML in revolutionizing TBI care. This review concludes by emphasizing the importance of bridging the gap between theoretical research and real-world clinical application and the necessity of addressing the ethical and privacy implications of integrating ML into healthcare.

Trauma Care doi: 10.3390/traumacare4010003

Authors: Andrea Munoz Samuel Girguis Loren Martin Michael Hollifield

This was a novel pilot study about the relationship between PTSD severity and resource gain and loss using the conservation of resources (COR) model with U.S. Veterans. Higher PTSD severity was predicted to be associated with greater resource loss scores, and lower PTSD scores were predicted to be associated with greater resource gain scores. The sample size was limited (N = 19) due to the COVID-19 outbreak. Veterans completed a demographic questionnaire, the Montreal Cognitive Assessment (MoCA), the Combat Exposure Scale (CES), the PTSD Symptom Scale–Interview (PSS-I), the Conservation of Resources–Evaluation (COR-E), and two additional open-ended questions. A statistically significant negative medium effect size was found between PTSD diagnosis and resource gain (r(17) = −0.42, p = 0.039, one-tailed). A large effect size in resource gain scores between PTSD and non-PTSD groups was also found (t(17) = 1.880, p = 0.077, d = 0.87), with the non-PTSD group reporting more gain of resources than the PTSD group. Post hoc tests revealed that the resource gain score of the mild PTSD group was significantly higher than that of the severe + very severe PTSD group (p = 0.034). Results suggest that resource gain, when compared to resource loss, was the strongest predictor for a non-PTSD diagnosis.

Trauma Care doi: 10.3390/traumacare4010002

Authors: Angela Sekely Hinza B. Malik Kayla B. Miller Yishi Wang Antonio E. Puente

Objective: Active-duty military personnel in the current wars have experienced unique stressors that deviate from standard PTSD assessment and diagnosis. This situation calls for a refinement of military-related PTSD assessment. To this end, this study assessed the utility of the Trauma Symptom Inventory (TSI) in diagnosing PTSD among active-duty military personnel. The past literature has validated the TSI using populations with a small sample size. Hence, this study aimed to fill the gap by using a large sample size of 670 military members to examine whether the TSI is useful for military populations. Setting: Participants were referred to Carolina Psychological Health Services, in Jacksonville, North Carolina by military neurologists and other qualified medical officers from the Naval Hospital in Camp Lejeune, a military base located in Jacksonville, NC, for neuropsychological evaluation due to reported cognitive deficits related to military deployment (i.e., head injury due to exposure to blast injuries). Participants: Based on clinical diagnosis, comprehensive neuropsychological testing, and self-reported data, personnel were classified into four groups: blast exposure (n = 157), PTSD diagnosis (n = 90), both blast exposure and PTSD (n = 283), and neither blast exposure nor PTSD (n = 140), which helps provide a comprehensive picture of the utility of the TSI. Results: The TSI’s 10 clinical scales could distinguish between all groups. Discriminant function analysis showed that an optimally weighted combination of scales correctly predicted 66.67% of PTSD-positive cases and 35.11% of PTSD-negative cases. Conclusion: These findings provide support for the use of the TSI in the assessment of PTSD in active-duty military personnel. Due to the release of TSI-2, there is a need to replicate this data. However, the validity data has indicated a high concordance between the TSI and TSI-2, bolstering confidence in the current findings of the study.

Trauma Care doi: 10.3390/traumacare4010001

Authors: Lise Mumporeze Chantal Uwamahoro Doris Uwamahoro Aly Beeman Destry Jensen Oliver Young Tang Enyonam Odoom Spandana Jarmale Stephanie C. Garbern Catalina González Marqués Andrew Stephen Adam R. Aluisio

In high-income nations, gender has been associated with injury characteristics. This study evaluated injury epidemiology and care based on gender at the Centre Hospitalier Universitaire de Kigali in Rwanda. Patients presenting to the emergency department with acute injuries were prospectively enrolled from 27 January–28 June 2020, and descriptive statistics were performed with comparisons between males and females. Of 601 patients, 25.6% were female and 74.4% were male. There were gender differences in the mechanism of injury, with females more likely to be injured in falls (43.5% versus 23.0%, p = 0.001); meanwhile, males were more likely to suffer road traffic accidents (52.6% versus 39.6%, p = 0.006). The severity of injury was similar between genders based on the mean Kampala Trauma Score (14.4 versus 14.7, p = 0.09). Females were more likely to have been transported by prehospital services (87.7% versus 72.9%, p = 0.001), and less likely to receive acute treatment during the first six hours of care (67.5% versus 78.1%, p = 0.009). There was no significant difference in mortality between females and males (2.0% versus 1.3%, p = 0.568). This study highlights differences in the epidemiology and care between males and females presenting for emergency injury care in Rwanda. These findings can inform future research and developments in gender-centered healthcare delivery.

Trauma Care doi: 10.3390/traumacare3040029

Authors: Jodie Murphy-Oikonen Jo-Ann Vis Rachel Egan

Decades of research have enhanced our understanding of the psychological impact of sexual victimization, including risk factors through which post-traumatic stress disorder (PTSD) manifests. Research on sexual assault and PTSD predominately reflects the experience of heterosexual women, yet sexual minorities are both at increased risk of sexual assault and suffer greater negative health outcomes from it. In these cases, PTSD is linked to a clearly identifiable cause, thereby making it possible to identify individuals at risk, enhance interventions immediately following the traumatic event, and offer services to mitigate further harm. This narrative review explores the potential risk factors for PTSS and PTSD among individuals who experience sexual assault and identify as a sexual minority. Knowledge of these compounding risk factors among service providers will assist in obtaining sexual assault disclosures in a sensitive and supportive manner, leading to the provision of early interventions to mitigate the risks of developing PTSD following sexual assault. The findings suggest that empirical investigation is urgently required to develop evidence-informed practices in providing targeted interventions for sexual and gender minorities following a sexual assault and mitigating further adverse health outcomes.

Trauma Care doi: 10.3390/traumacare3040028

Authors: Julie C. Avery Emma Galvin Joanne Deppeler Helen Skouteris Justin Roberts Heather Morris

The aim of this study is three-fold: (1) to explore multiple community member views of core elements of trauma-responsive practice at a specialist school; (2) to explore impact on student wellbeing and learning outcomes, and educator experiences of their workplace; and (3) to explore insights into implementation challenges and enablers. This study uniquely incorporates four participant cohorts: parents or caregivers, educators, and community agencies involved with school students and their families. It utilises a mixed-methods approach with an emphasis on the voice of participants and their lived experience of a trauma-responsive specialist school. The data identify a trauma-responsive school culture, high staff satisfaction, improved student wellbeing and attendance, and progress towards learning goals. Reflective analytic themes centre on a collective experience of the school as a connected community, emphasising relationships, safety, collaboration, mutuality, voice, and empowerment. Findings show that the practices most valued across the cohorts centre on the collective experience of the school as a connected community, emphasising relationships, safety, deep listening, collaboration, mutuality, voice, and empowerment. Trauma-informed principles frame the discussion and implications for equity-focused trauma-responsive practice and policy development. Implications for practice and policy development are discussed.

Trauma Care doi: 10.3390/traumacare3040027

Authors: Varun Sambhariya Tyler Roberts Colin Ly Alison Ho William F. Pientka

Purpose: Early loss of reduction remains a challenging complication in distal radius fracture management. There are limited data on factors that correlate with early loss of reduction. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification has become a popular way of evaluating complex fracture patterns. This study aims to determine the impact of fracture pattern, as determined by the AO classification, on restoration of intraoperative parameters, early loss of reduction, and time to fracture union in operatively treated distal radius fractures. Methods: Following IRB approval, adult patients with surgically treated acute distal radius fractures at a single level I institution were identified. Retrospective chart and radiographic review were used to obtain AO classification, postoperative radiographic parameters, early loss of reduction, time to fracture union, as well as any complications. Results: 422 patients with operatively treated distal radius fractures were included in this study. Across fracture patterns, there were no significant differences in restoration of radial height or inclination. Higher severity fracture classifications had decreased restoration of volar tilt. Overall, simple fractures (A2, C1) and partial articular fractures (B1, B2, B3) had higher rates of satisfactory alignment restoration compared to comminuted fractures (A3, C2, C3). Although there were differences in restoration of radiographic parameters, fracture type did not correlate with loss of reduction within 30 days. C type fractures correlated with increased weeks to radiographic healing. Conclusions: This study establishes that distal radius fracture pattern, as determined by the AO classification, has a significant impact on intraoperative restoration of parameters but does not correlate with early loss of reduction. Furthermore, more difficult fracture patterns may have a longer time to fracture union, but fracture type does not appear to have an effect on postoperative complications.

Trauma Care doi: 10.3390/traumacare3040026

Authors: Gaylene Armstrong Taylor Gonzales Michael R. Visenio Ashley A. Farrens Hannah Nelson Charity H. Evans Jennifer Burt Zachary M. Bauman Mark Foxall Ashley A. Raposo-Hadley

Introduction: Personal, behavioral, and environmental risk factors are correlated to varying degrees with each other and with the overall likelihood of violent reinjury. When used with fidelity, risk assessment instruments, including the violence reinjury risk assessment instrument (VRRAI), identify domains in which individuals present elevated risk levels to aid in matching services with needs. Less is known about the collinearity among risk factors for violently injured individuals admitted to hospitals. Collinearity between risk factors has ramifications for predictive modeling of violent reinjury risk. The objective of this study was to identify significantly correlated risk factors when the VRRAI was used by hospital-based violence intervention programs (HVIP) for clients. Materials and Methods: Victims of violent injury by modality of firearm, stabbing, and physical assault who were admitted to a level 1 trauma center at a single institution were voluntarily enrolled in a hospital-based violence intervention program (HVIP) between September 2020 and June 2022. Violence intervention specialists (VIS) completed the VRRAI within the first month of participant enrollment. The VRRAI is comprised of 29 binary indicators that may signal elevated risk of violent reinjury. Data from completed assessments were used to apply risk-need-responsivity (RNR) principles along with phi coefficients of key indicators to examine overlap and prevalence in the population. Results: A total of 98 participants were enrolled in the HVIP. The median age was 27 years old and 79 (80.6%) were male, while 66 (67.3%) were non-Hispanic Black or African American, 9 (9.2%) were non-Hispanic White, and 17 (17.3%) identified as Hispanic or Latino. Several statistically significant relationships existed between key risk indicators in the VRRAI. Importantly, a robust relationship was found between the two dynamic risk factors of having heavy connection with gangs and a perception of imminent threat of violence (φc = 0.57, p < 0.01). Conclusion: Data suggest that some variables could be consolidated or removed from the VRRAI to create an even shorter instrument that can be performed more rapidly in the clinical setting. The application of the RNR model illustrates a limited number of dynamic risk factors that could be immediately addressed as part of case management should be prioritized among the questions selected from the VRRAI for inquiry at the intake assessment.

Trauma Care doi: 10.3390/traumacare3040025

Authors: Khasim Zakaria Haider Zubair Ahmed

Since 1995, it has been known that carbohydrate drinks (CHDs) can be safely consumed two to three hours (2–3 h) preoperatively. Furthermore, preoperative CHDs significantly benefit many outcomes, such as thirst, hunger, and insulin resistance. Patients, however, still fast excessively. This study aimed to determine if a CHD, consumed 2–3 h preoperatively, impacts postoperative inflammation compared to a placebo drink or fasting. This was achieved through analysing the levels of interleukin-6, C-reactive peptide, and serum albumin 10–24 h postoperatively. We conducted a systematic review of randomised control trials. We comprehensively searched the Embase, MEDLINE and Web of Science databases, identified 473 studies, and, after screening, were left with 10 randomised control trials. Our meta-analyses found a significantly lower mean interleukin-6 level of −21.26 pg/mL ((95% CI −33.37, −9.15); p = 0.0006) postoperatively in patients given a preoperative CHD compared to fasting and a significantly higher mean serum albumin level of 2.56 g/L ((95% CI 1.41, 3.71); p < 0.0001) postoperatively in patients given a preoperative CHD compared to a placebo. Our results therefore show that a CHD, consumed 2–3 h preoperatively, lowers proinflammatory cytokine levels and increases serum albumin levels. Thus, our study reinforces guideline recommendations to give patients a CHD 2–3 h preoperatively for improved outcomes.

Trauma Care doi: 10.3390/traumacare3040024

Authors: Alexander J. Lee Lucas S. LaFreniere

The United States Department of Veterans Affairs (VA) uses a systematized approach for disseminating evidence-based, trauma-focused psychotherapies for post-traumatic stress disorder (PTSD). Within this approach, veterans with PTSD must often choose between Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), each delivered in their standard protocols. Many veterans have been greatly helped by this approach. Yet limiting trauma-focused therapy to these two options leaves the VA unable to fully address the needs of a variety of veterans. This limitation, among other factors, contributes to the suboptimal attrition rates within the VA. The present review proposes solutions to address treatment barriers that are both practical (such as time and travel constraints) and psychological (such as resistance to trauma exposure). By reducing barriers, attrition may lessen. Proposed countermeasures against practical barriers include intensive protocols, shortened sessions, telehealth, smartphone application delivery, or any combination of these methods. Countermeasures against psychological barriers include alternative evidence-based treatment programs (such as Acceptance and Commitment Therapy), intensive protocols for exposure-based treatments, and the integration of components from complementary treatments to facilitate PE and CPT (such as Motivational Interviewing or family therapy). By further tailoring treatment to veterans’ diverse needs, these additions may reduce attrition in VA services for PTSD.

Trauma Care doi: 10.3390/traumacare3040023

Authors: Vicki Bitsika Christopher Francis Sharpley

There is some evidence that autistic children experience more traumatic events than non-autistic children, but little research attention has been given to sex differences on this issue. This study investigated the presence of sex-based differences in the occurrence and severity of trauma-related events and resultant stress in autistic youth, and tested the null hypothesis of no sex differences. A sample of 32 autistic males and 32 autistic females (6 yr to 18 yr), plus one of their parents, participated in a survey study of (a) the presence of a traumatic event and ongoing stress regarding that event, and (b) recurrent memories or dreams of that event. Although the autistic children rated their experience of trauma, plus their recurrent memories or dreams of that event, as more severe than their parents did, neither of these sources of information showed any significant sex differences in the total score or diagnostic frequency for trauma-related stress. There were no significant correlations between age, IQ, or autism severity and trauma-related stress scores for the autistic males or females. These results challenge the generalizability of the prevalence of sex differences in trauma-related stress that has been reported in the wider community, arguing that equal attention should be given to male and female autistic youth for this possible comorbidity.

Trauma Care doi: 10.3390/traumacare3040022

Authors: Doriane Deloye Alexandra Nadeau Amanda Barnes-Métras Christian Malo Marcel Émond Lynne Moore Pier-Alexandre Tardif Axel Benhamed Xavier Dubucs Pierre-Gilles Blanchard Eric Mercier

Sex disparities in access and quality of care are well known for some time-sensitive conditions. However, the impact of sex on early trauma care remains unknown. In this study, we compared delays of completion of life-saving interventions (LSIs) between females and males among severely injured patients. This is a retrospective cohort study of all patients who consulted or were transported by ambulance in the emergency department (ED) of a level-one trauma centre following injury between September 2017 and December 2019 and for whom at least one LSI was performed. The list of LSIs was established by an expert consensus and included trauma team leader (TTL) activation, endotracheal intubation, chest decompression, blood transfusion, massive transfusion protocol, neurosurgery, spinal surgery, intestinal surgery, and spleen, liver and/or kidney angiography. A total of 905 patients were included. No significant statistical differences in the LSI delays were found when comparing females and males brought directly to the ED and transferred from another health care setting. Results of this study suggest that delays before completion of LSIs are similar for severely injured patients at our major trauma centre regardless of their sex.

Trauma Care doi: 10.3390/traumacare3040021

Authors: Bridget N. Jules Victoria L. O’Connor Jennifer Langhinrichsen-Rohling

Infidelity, a betrayal within a romantic partnership, often violates a person’s core beliefs about themselves and their significant other and can influence the degree to which a person can feel safe in romantic relationships. Infidelity can also increase exposure to sexually transmitted diseases that can compromise physical and mental health. Therefore, infidelity can be judged as central to one’s identity and potentially traumatic, possibly triggering outcomes similar to other DSM-5 Criterion A traumas. The current research examines the contribution of centrality perceptions to the development of PTG and PTS post-infidelity. Bivariate regressions examined the relationships between the judged centrality of infidelity and PTG and PTS, respectively. Exploratory analyses considered the moderating role of relationship form (i.e., casually dating, exclusively dating, and engaged/married) on those relationships. In a sample of 177 adults, greater judgments of the centrality of infidelity were associated with both PTG and PTS. Results demonstrated a significant moderating effect of relationship form on the relationship between the centrality of infidelity and PTG but not between the centrality of infidelity and PTS. Moderation results demonstrated that if infidelity is considered central in a casually dating relationship, it is more strongly related to PTG than in other relationship forms. Considering infidelity as central may generate both beneficial and problematic post-traumatic outcomes. However, an early infidelity experience may provide increased opportunities for engagement in different behaviors in the future (e.g., selecting a different partner, setting different relational boundaries), which, in turn, may be more conducive to growth.

Trauma Care doi: 10.3390/traumacare3040020

Authors: Amy Thandeka Crankshaw Veronica Melody Dwarika

An acknowledgement that the legacy of apartheid lives on in the minds of South Africa’s born free generation necessitates an exploration of psychologists’ interventions for transgenerational trauma. This research aimed to contribute to research on this subject by interviewing South African psychologists with the ultimate objective of assisting professionals who formulate interventions. Firstly, the ways in which psychologists identify transgenerational trauma were explored. This provided a foundation for exploring the psychologists’ interventions for transgenerational trauma and contributed to a discussion of how interventions could be enhanced. Thematic analysis of the semistructured interviews revealed that stuckness paired with guilt, grief resulting from silence and certain manifestations of identity and relationship issues are identifiers of transgenerational trauma. The findings also pointed to the utility of certain approaches to individual, group, family and community interventions. Recommendations for enhancing psychologists’ interventions for transgenerational trauma in Gauteng’s born free generation revealed the imperative for psychologists to actively engage in professional and personal growth, predicated on the complexity of the challenges within.

Trauma Care doi: 10.3390/traumacare3030019

Authors: Lisa Tamburini Francine Zeng Dillon Neumann Casey Jackson Michael Mancini Andrew Block Seema Patel Ian Wellington David Stroh

Tibial shaft fractures are a commonly seen injury in orthopedic trauma patients. Fractures commonly occur following high energy mechanisms, such as motor vehicle collisions. There are multiple ways to stabilize tibial shaft fractures. Knowledge of the indications, contraindications, techniques, and complications associated with each technique allows the orthopedic surgeon to make the appropriate decision for each patient by providing both fracture and patient characteristics. This review discusses the indications, techniques, outcomes, and complications associated with intramedullary nailing, minimally invasive percutaneous plate osteosynthesis, and external fixation of tibial shaft fractures.

Trauma Care doi: 10.3390/traumacare3030018

Authors: Joseph Mendlovic Idan Haklay Roxanne Elliott Mooli Lahad

This study examines the psychological repercussions of the COVID-19 pandemic on a medical team in an Israeli general hospital. The research explores the professional quality of life, burnout symptoms, secondary traumatic stress, and mindfulness among team members across three distinct phases of the pandemic. Analysis was conducted for different subgroups based on job roles and seniority, allowing for an evaluation of the phase-specific effects on ProQOL (Professional Quality of Life) and mindfulness. Results align with established crisis trajectories: honeymoon/heroic phases, inventory, disillusionment, and recovery. As a result of the prolonged pandemic and the need to change shifts and recruit staff to deal with the affected patients, it is an accumulative study not following the same person but the same ward and the same hospital. The findings suggest a negative correlation between compassion satisfaction and burnout, as well as between mindfulness and burnout/secondary traumatic stress. Unlike most studies, healthcare workers (HCWs) were less affected than doctors in all measures. This study highlights doctors’ vulnerability and underscores hospital management’s key role in promoting effective support for professional quality of life. This is especially important for male doctors facing distinct well-being challenges.

Trauma Care doi: 10.3390/traumacare3030017

Authors: Kirsten Byrnes HaeSung Han Kie Fujii

The impact of early maternal age on several outcomes (e.g., mental health issues, delinquency, aggression, impulsivity, victimization, and interpersonal difficulties) has been studied since the late 1980s. Research has demonstrated links between exposure to adverse childhood experiences (ACEs) and trauma-related outcomes such as substance abuse, interpersonal and self-directed violence, and sexual risk-taking, to name a few. The current study analyzed the incidence of ACE exposure and mental health outcomes (e.g., suicidal behaviors or self-harm, psychiatric hospitalizations, and substance use) as related to early maternal age in youth known to have experienced trafficking or sexual abuse. General demographics and incidence of various experiences and clinical presentations (e.g., ACE exposure, age of mother at birth of youth, and age at first birth), and history of self-harm, substance use, and psychiatric hospitalization, were examined in a sample of 225 youth referred for services subsequent to experiences of sex trafficking or exploitation. Relationships between ACE exposure and maternal age related to mental health outcomes were also examined. Trafficked and exploited youth reported rates of ACE exposure and poor mental health outcomes at far greater rates than the general population. Significant findings were related to early maternal age and engaging in self-harm or suicidal behaviors. Previously anticipated mediational analyses were not conducted due to the sample size and lack of correlations. Findings highlight the significant ACE exposure and high needs of exploited, trafficked, and abused youth and related mental health outcomes, emphasizing the need for early and comprehensive preventive and therapeutic interventions.

Trauma Care doi: 10.3390/traumacare3030016

Authors: Fran Hearn Laura Biggs Stephanie J. Brown Ann Krastev Josef Szwarc Elisha Riggs

For women and families of refugee background having a baby in Australia, trauma-related experiences contribute to maternal and neonatal health inequities. Group Pregnancy Care for women of refugee background is a new model of care that was codesigned with communities of refugee background, to incorporate a trauma-informed approach to care. The aim of this paper is to explore how trauma-informed care is understood by Group Pregnancy Care professional staff. An exploratory descriptive qualitative study involving twenty-three semi-structured interviews with past and present professional staff was conducted. Data were analysed using reflexive thematic analysis. The results reported in this paper include five themes: acknowledging the universal potential for trauma; accountability to community; practising in trauma-informed ways; how can we determine whether trauma-informed care is happening?; and understanding equity. The analysis showed that GPC staff aimed to practise in trauma-informed ways and understood that their ability to integrate trauma-informed care could improve over time. However, there were times when participants perceived organisation- or structural-level barriers that were incongruous with their understanding of health equity, which created tension and led to feelings for some of being in a ‘battle against the system’. Key individual- and organisation-level factors were identified that assisted with integrating trauma-informed care, including a safe and accessible space to hold the program, strategies to minimise the risk of retraumatisation and burnout, and adequate time to facilitate group processes and support staff to participate in team reflective practises. Understanding trauma-informed care and equity were seen to have important implications for workforce wellbeing and the promotion of refugee maternal and child health.

Trauma Care doi: 10.3390/traumacare3030015

Authors: Sungjin Im

Individuals with traumatic experiences may develop symptoms of post-traumatic stress disorder (PTSD) and co-morbid disorders, such as anxiety disorders, major depression, and substance use disorder. Although exposure therapy is considered the “gold standard” for the treatment of PTSD, dropout rates and patient distress are relatively high. One promising approach is live Z-score neurofeedback (ZNF) training, but clinical evidence is sparse. Thus, the current study aimed to evaluate the feasibility and acceptability of ZNF training among individuals with PTSD. After undergoing a diagnostic interview utilizing the MINI Neuropsychiatric Interview, nine patients with PTSD (7 females; mean age = 20.75 [SD = 2.38]) completed ten ZNF sessions, lasting 20 min each, and the PCL-5 at pre- and post-treatment. Over the course of the study, only a few minor study disruptions, adverse events, and patient complaints were reported, and participants rated high on feasibility and acceptability. Results from repeated measures ANOVAs suggest significant improvements in overall PTSD symptoms. Although these findings need to be replicated in larger samples with active control groups, the current study provides support that ZNF is a safe, acceptable, and potentially effective treatment for PTSD.

Trauma Care doi: 10.3390/traumacare3030014

Authors: Nicole B. Lyons Walter A. Ramsey Brianna L. Cohen Christopher F. O’Neil Cristina Botero-Fonnegra Carlos T. Huerta Aris Arakelians Sinan Jabori Kenneth G. Proctor Wrood Kassira Joyce I. Kaufman Edward B. Lineen Devinder Singh Nicholas Namias

Liposuction is one of the most commonly performed aesthetic plastic surgery procedures in the world. Although serious complications are rare, intra-abdominal complications such as bowel perforation are one of the most common causes of death after liposuction. We present a case series of six patients who sustained intra-abdominal injuries from liposuction. The acute care surgery (ACS) faculty at a single institution were surveyed for patients. Six patients were identified over a three-year period. The average age was 45 years, and all patients were female. All six underwent a cosmetic procedure in addition to their liposuction. Four (67%) had previous abdominal surgery, and five (83%) were overweight or obese. All patients presented with abdominal pain, tachycardia, and leukocytosis. All six underwent exploratory laparotomies: four patients had small bowel enterotomies, one had cecal volvulus and abdominal compartment syndrome, and one had fascial violation. They underwent an average of four ACS procedures (range 1 to 11) and had an average hospital LOS of 29 days (range 5 to 60) and an average ICU LOS of 11 days (range 1 to 39). Intra-abdominal injuries are a rare complication of liposuction; however, a high index of suspicion must be maintained to diagnose and treat these life-threatening injuries.

Trauma Care doi: 10.3390/traumacare3030013

Authors: Leah Lefakane Nonhlanhla Maseko

Disability is associated with negativity, discrimination, shame, and stigma in townships, which impacts how parents interpret it when their child has a disability. Parents who have recently learned of their children’s intellectual disability often experience psychological and emotional trauma due to uncertainty and lack of knowledge and understanding of intellectual disabilities, including a lack of formalized and policy-supported transition programs in South Africa. Guided by Barbara Mowder’s Parent Development Theory, this study aimed to explore parents’ understanding of their role in transitioning learners with intellectual disabilities from mainstream to special schools. Using a qualitative case study, semi-structured interviews were conducted with eight purposively sampled participants from one chosen mainstream primary school in Soweto, Gauteng Province, South Africa. The results of the current study confirmed that the meanings participants attribute to their parent role characteristics during the transitioning of their children with intellectual disabilities are influenced by the connection between the Parent Development Theory’s parent role perceptions and the participants’ individual factors, including their educational background levels, which made a major contribution to how these parents perceived their parental role and their understanding of intellectual disabilities. The results highlight that owing to parents’ educational levels and cultural aspects, identifying learners with intellectual disabilities can be particularly challenging, with overwhelming, mixed emotions. The provision of psychosocial services in mainstream schools, as well as teacher training in skills to address the overwhelming parental support needs, will benefit parents and their intellectually disabled children by facilitating therapy and counseling during the transition process to overcome psychological challenges.

Trauma Care doi: 10.3390/traumacare3030012

Authors: Kala Mayer Sally Rothacker-Peyton Kaye Wilson-Anderson

Background: Ongoing evidence of trauma in nurses, beginning in nursing school, requires educators to take a trauma-informed approach to teaching and learning to minimize re-traumatization and to ultimately achieve socially-just student outcomes. Methods: The purpose of this study was to evaluate the outcomes of trauma-informed educational practices (TIEP) on nursing students and the trauma-informed climate in the classroom using an intervention comparison group pre-posttest design. Results: Secondary traumatic stress (STS) scores declined for both groups pre- to post-test. There was a statistically significant difference in STS change scores between intervention and comparison groups (p < 0.05), but not in the direction hypothesized. Conclusion: Findings from this study indicate that other factors in the nursing classroom might have contributed significantly to a reduction in STS. In addition to outcomes, future TIEP evaluations should explore student awareness and experiences of trauma, resilience, professional preparation, and learning outcomes in the classroom setting.

Trauma Care doi: 10.3390/traumacare3030011

Authors: Yuchen You Javier Romero Graal Diaz Robin Evans

Background: Craniofacial injuries are thought to be commonly associated with traumatic brain injury (TBI), but there is conflicting evidence in the literature. This retrospective cohort study aims to evaluate the incidence of TBI in patients with craniofacial trauma. Methods: The study included 2982 consecutive patients with either solitary or concurrent diagnoses of TBI and facial fractures, seen and evaluated at a single level II trauma center between 1 January 2010 and 31 December 2020. Continuous variables were compared against whether the patient had one or both diagnoses. Results: Of the target population, 55.8% had a solitary diagnosis of TBI; 30.28% had a solitary diagnosis of facial fractures; and 13.92% had concurrent diagnoses of both TBI and facial fractures. Patients with concurrent diagnoses had a significantly longer mean length of stay (LOS) compared to those with solitary diagnoses (9.92 ± 16.33 days vs. 6.21 ± 10.96 days, p < 0.01), but age (p = 0.68) and ICU LOS (p = 0.09) did not differ significantly between the two groups. Conclusions: Trauma to the face should be given special attention due to the increased chance of TBI with craniofacial fractures. Patients with concurrent diagnoses of TBI and facial fractures had worse hospital outcomes than those with solitary diagnoses of either TBI or facial trauma.

Trauma Care doi: 10.3390/traumacare3020010

Authors: Portia Jackson Preston Gregory Chris Brown Tiffani Garnett Delia Sanchez Esther Fagbamila Natalie Graham

Black higher education professionals are more likely to be under-represented and experience racial discrimination and to be approached by students with whom they share identity characteristics for support, compared to white counterparts. This study explored experiences of stress potentially leading to secondary traumatic stress or burnout and coping efforts in Black-identifying staff (n = 35), who were a subset of a larger sample (n = 559) representing twenty-two U.S. regional universities. Compared to the larger sample, Black respondents were more likely to be in their roles for three years or less, potentially indicating higher rates of turnover. The Sort and Sift, Think and Shift Method was used to conduct a qualitative analysis of participant responses to open-ended questions regarding role-related stressors, efforts to cope, and desired institutional resources. Many staff reported role challenges consistent with experiences of secondary traumatic stress and burnout, which they coped with by engaging in a range of mindful self-care practices (e.g., sustaining supportive relationships, finding meaning in their work, promoting their physical health, setting boundaries). Participants highlighted the urgency of the need for change to institutional infrastructure, policies, and practices to support manageable workloads and treat staff with respect. It is critical for institutions to take an active and intentional role in mitigating stressors that contribute to secondary traumatic stress or burnout by addressing racial battle fatigue, providing adequate resources to meet the needs of under-represented students, protecting the capacity of staff to utilize wellness resources on campus, enhancing role clarity and autonomy, and fostering a sense of cultural pride, respect, and accomplishment, as well as other mechanisms, to create a culture that promotes and sustains the wellbeing of Black staff.

Trauma Care doi: 10.3390/traumacare3020009

Authors: Belinda L. Dow Justin A. Kenardy Robyne M. Le Brocque Debbie A. Long

This study aimed to identify predictors, especially cognitive predictors, of posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD) in children 6 months after Paediatric Intensive Care Unit (PICU) admission. Participants were 55 children aged 6–16, admitted to PICU for at least 8 h. Medical data were collected from patient charts. Cognitive variables (peri-trauma affect, cognitive processing and trauma memory) were assessed by interview and self-report questionnaires 2–4 weeks and 6 months following PICU admission. Acute PTSS at 2–4 weeks were assessed by self-report questionnaire and PTSD at 6 months was assessed by clinical interview. Receiving ketamine in PICU was the only non-cognitive variable associated with PTSS at 6 months. Peri-trauma affect, cognitive processing, and trauma memory significantly and independently accounted for 21% of the variance in PTSS at 6 months even after controlling for acute PTSS (and ketamine). A mediation analysis showed that peri-trauma affect indirectly influenced PTSS at 6 months through its effect on cognitive processing. Conclusions: Cognitive variables significantly contribute to PTSS in children, following PICU admission. Peri-trauma affect influenced PTSS only via disrupted cognitive processing. Prevention or early intervention strategies aimed at helping children develop a complete, contextual trauma narrative may be effective in reducing persistent posttraumatic stress responses in children following PICU.

Trauma Care doi: 10.3390/traumacare3020008

Authors: Lorinda Riley Anamalia Suʻesuʻe Meldrick Ravida

Indigenous communities in North America have distinct colonial histories with their own story of how their ancestors were able to survive the mass effort to take their land, resources, language, culture, and sometimes even their lives. These stories have been passed down orally and through the DNA of the descendants of survivors via epigenetics. The Historical Loss Scale (HLS) and Historical Loss Associated Symptoms Scale (HLASS) are two validated scales that measure historical trauma among Native Americans. However, as different Indigenous communities have different colonial histories, it is critical to ensure that tools used to measure historical trauma are valid for that specific communities. When these scales are applied to Native Hawaiians, these measures may not provide an accurate picture of the historical trauma experienced by Native Hawaiians. As part of the effort to adapt the HLS for Native Hawaiians, we conducted a crosswalk analysis of the HLS and HLASS with a recent study on Native Hawaiian historical trauma (NHHT) to identify areas of overlap and divergence. We found that while there was significant overlap, several areas of divergence emerged likely stemming from the unique colonial histories of different Indigenous communities.

Trauma Care doi: 10.3390/traumacare3020007

Authors: Karina Sá M. Magno e Silva José Gorla Anselmo Costa e Silva

Background: Knowledge and understanding of the most diverse aspects surrounding the emergence of sports injuries stand out as one of the pillars for sporting success. Methods: A total of 41 athletes answered an online form based on the Sports Injury Protocol in Paralympic Sports (PLEEP) in which data on sports injuries during competition in the first Brazilian wheelchair basketball division were collected. Results: The athletes who composed the sample perform a high volume of training. The majority did not present with injuries before the competition. There was a prevalence of 17.1% of injuries during the competition, an incidence of 0.17 injuries per athlete and an incidence rate of 0.03 injuries per athlete-hour or four injuries per one thousand athletes-days. The injuries that occurred during the competition were mostly in the shoulder region, characterized as traumatic, by indirect contact with other athletes, which occurred when propelling the wheelchair, and were of low severity. Conclusions: The wheelchair basketball athletes presented a low prevalence, incidence and incidence rate of injuries during the competition. The shoulder region was the most affected. Structuring training sessions with the prevention of injuries in the shoulder region in mind is essential for these athletes to perform optimally.

Trauma Care doi: 10.3390/traumacare3020006

Authors: Reidar P. Lystad Andrew Fyffe Rhonda Orr Gary Browne

This study aimed to quantify changes in paediatric injury-related Emergency Department (ED) presentations at a large metropolitan paediatric hospital during the first two years of the COVID-19 pandemic (i.e., 2020 and 2021). This retrospective cohort study included children aged ≤15 years who presented to the ED at the Children’s Hospital at Westmead, Sydney, New South Wales, Australia, with a principal diagnosis of injury during 1 January 2010 to 31 December 2021. Annual and monthly incidence of paediatric injury-related ED presentations from 2010 to 2019 were used to fit autoregressive integrated moving average models, from which forecast estimates with 95% prediction intervals were derived and compared against corresponding observed values to obtain estimates of absolute and relative forecast errors. The distributions of injuries by injury severity in 2020 and 2021 were compared against the 2010–2019 reference period. The annual incidence of paediatric injury-related ED presentations was 7.6% and 4.7% lower than forecasted in 2020 and 2021, respectively, equating to an estimated total of 1683 fewer paediatric injury-related ED presentations during the two-year period. The largest reductions in monthly incidence of paediatric injury-related ED presentations were observed during the periods of major societal restrictions (i.e., March–May 2020 and July–October 2021). Significant reductions in monthly incidence of injury-related ED presentations were observed for minor injuries only, with no discernable reductions in moderate and serious injuries. These findings highlight the impact of the COVID-19 pandemic on paediatric injury-related ED presentations and the need for future epidemiological studies examining secular trends in paediatric trauma volumes to account for the impact of the COVID-19 pandemic.

Trauma Care doi: 10.3390/traumacare3010005

Authors: Gül Dikeç Kübra Timarcıoğlu

Background: Due to experiencing traumatic and stressful events, refugees are at risk of having mental disorders. The refugees might need to use psychotropic agents to treat mental disorders. It is essential to understand this population’s adherence rate to psychotropic medication. Aim: This study aimed to evaluate adherence to psychotropic medication and the relationship with psychiatric symptoms among Syrian refugees in Turkey. Method: The study design was descriptive and correlational. The study was conducted with 55 Syrian refugees attending a community health center in southern Turkey. The data was collected with General Medication Adherence Scale–Arabic Version (GMAS–AR) and Brief Psychiatric Inventory (BPI). Results: 78.2% (n: 43) of the participants’ medication adherence was poor, and a significant negative and weak correlation was found at 0.01 level between GMAS–AR and BPI (r: −0.37). According to multiple linear regression analysis, the model with gender and BPI was significant, and this model explained 19% of GMAS–AR total points (p < 0.001). Conclusion: Mental health professionals should test the effectiveness of psychosocial interventions that increase adherence to treatment for the cultural characteristics of societies.

Trauma Care doi: 10.3390/traumacare3010004

Authors: Stephanie Chassman Blair Bacon Sara Chaparro Rucobo Grace Sasser Katie Calhoun Emily Goodwin Kim Gorgens Daniel Brisson

The rates of traumatic brain injury (TBI) are higher among individuals experiencing homelessness compared with the general population. Individuals experiencing homelessness and a TBI may experience barriers to care. COVID-19 may have further impacted access to basic resources, such as food, shelter, and transportation for individuals experiencing homelessness. This study aimed to answer the following research question: What is the impact of COVID-19 on access to resources among individuals experiencing homelessness and TBI? A cross-sectional study design and purposive sampling were utilized to interview 38 English-speaking adults experiencing homelessness and who had sustained a TBI (ages 21–73) in one Colorado city. Qualitative questions related to the impact of COVID-19 were asked and qualitative analysis was used to analyze the responses. Three primary themes emerged regarding the types of resources that were restricted by COVID-19: basic/biological needs, financial needs, and a lack of connection. COVID-19 has shown the social work field the need for continued innovation and better practice standards for individuals who are not housed. For those living with a reported TBI history and experiencing homelessness, COVID-19 made it difficult to access basic services for survival.

Trauma Care doi: 10.3390/traumacare3010003

Authors: Trauma Care Editorial Office Trauma Care Editorial Office

High-quality academic publishing is built on rigorous peer review [...]

Trauma Care doi: 10.3390/traumacare3010002

Authors: Raphael Borinuoluwa Zubair Ahmed

Blast mild traumatic brain injury (mTBI) is a unique injury in the military population and post-traumatic stress disorder (PTSD) is shown to be linked with it. The main purpose of the systematic review was to understand the impact of blast mTBI on PTSD symptom severity. We systematically searched Pubmed, Web of Science, Embase (Ovid), APAPsycINFO (Ovid) and Medline (R) and In-Process, In-Data-Review and Other Non-Indexed Citations (Ovid). Data extraction and quality assessment was completed using the AXIS tool. Statistical analysis was undertaken to determine differences between blast mTBI and the control group (no blast and no TBI in military personnel) and a meta-analysis using the random effects model was used to calculate between-study heterogeneity and variance through I2 and Tau2, respectively. Additionally, the likelihood of PTSD, analysed using the average PTSD Checklist (PCL) score, was also determined based. Statistically higher PCL scores were found in the blast mTBI group compared to control groups, but high heterogeneity was found between the studies (p < 0.001, I2 = 84%, Tau2 = 0.44). Furthermore, all studies reported that blast mTBI had probable PTSD, but this was not the case for the control group. Blast mTBI appears to impact on PTSD symptom severity and the likelihood of developing PTSD, which healthcare professionals need to be aware of. The high heterogeneity present in the studies means that caution must be exercised when interpreting the data from this study. However, future studies require more well-defined, high-quality studies to answer the question of how blast mTBI affects PTSD symptom severity.

Trauma Care doi: 10.3390/traumacare3010001

Authors: Samantha J. Beningfield Emily A. Webber George V. Oosthuizen Sharon R. Čačala

Introduction: Potassium Permanganate (KMnO4) is an uncommon cause of caustic ingestion in teenagers and adults; only case reports are found in the recent literature. At Ngwelezana Hospital in South Africa, KMnO4 ingestion is not an uncommon indication for admission. KMnO4 is readily available as used in most households and recommended for medicinal purposes by traditional health practitioners. Aim: To ascertain the reasons for KMnO4 ingestion, the extent and severity of injury as determined by upper gastro-intestinal studies, and patient outcomes in comparison with the available global literature. Methods: We performed a retrospective study of 26 teenage and adult patients, admitted to our adult wards following KMnO4 ingestion. Data collected on patient demographics, reason for KMnO4 ingestion, and quantity ingested. Oral inspection and upper gastro-intestinal study findings recorded with grading (Zargar) of corrosive injury to oesophagus and stomach. Patients’ outcome and duration of hospital stay documented. Results: There were 73% females and 27% males, with an average age of 23 years. Reasons for ingestion included parasuicide (84%), accidental ingestion (8%), and for relief of abdominal pain (8%). The vast majority (96%) swallowed KMnO4 in solution rather than in solid form. The volume and concentration of KMnO4 taken was difficult to quantify. Oral discoloration, oedema, and ulceration were found in 58%. Gastro-intestinal endoscopy was performed in 92%; abnormalities were demonstrated in 68% (oesophageal injury 14%, oesophageal and gastric injuries 14%, gastric injury alone 41%). Oesophageal injuries: n = 6; Zargar grade 1—83%, Zargar grade 2A—17%. Gastric injuries: n = 12; Zargar grade 1—42%, Zargar grade 2A—33%, Zargar grade 2B—25%. Average hospital stay was 2.9 days (range 2–8 days). There were no mortalities and no complications at 6 weeks. Conclusion: KMnO4 ingestion by teenagers and adults is not uncommon in our setting, mostly related to suicide attempts and most often taken in liquid form. KMnO4 was possibly of a low concentration as no systemic complications were noted and there were milder gastric and oesophageal injuries as compared to case reports from elsewhere of mucosal necrosis following ingestion of KMnO4.

Trauma Care doi: 10.3390/traumacare2040050

Authors: Nicole Dubus

Ever since World War II, forced migrations have increased exponentially, shaping our world, economies, and political discussions. When the United Nations formed the United Nations High Commissioner for Refugees (UNHCR) in 1950, it could not predict the escalation of forced migration from civil unrest, personal persecution, war, and recently, climate crises. As forced migrations increase, we must understand the emotional trauma involved, and how to mitigate it. This study examined how providers of refugee services understand, assess, and treat trauma in the forced migration population. This paper is based on qualitative data collected from social work providers who work with forced migrants. Transcribed interviews were analyzed through content analysis regarding assessment and treatment approaches. The findings show that the lack of trauma-informed care was prevalent among the participants. This was reflected in the participants’ experiences. Three main themes emerged: (1) trauma was misdiagnosed; (2) few were trained in evidence-based practices to manage trauma; and (3) providers felt isolated in their work as if working in silos. These themes and their implications are discussed.

Trauma Care doi: 10.3390/traumacare2040049

Authors: Michelle M. Lepak

Trauma can result in many long-term symptoms including emotional dysregulation, depression, addiction, and PTSD. When triggered by trauma, patients typically experience the world through a myopic lens. Helping clients observe and sense their trauma sequelae in the broader sensory awareness of Presence appears to help clients more easily process and resolve traumatic experience. The Presence Psychotherapy Trauma Protocol (PPTP) provides specific open-ended questions in session to help clients orient to Presence Awareness which can then be utilized to resolve trauma. Options to help clients sense their traumatic experience in the expansive awareness of Grounded Presence, Spacious Presence, Relational Presence, or Transcendent Presence create multiple regulating, processing, and attachment healing opportunities. PPTP’s concept of Reflective View is introduced which provides the clinician with prompts to help the client identify who they are as Presence Awareness early in session. This paper demonstrates, through a case example, how Presence Awareness and specifically Reflective View help clients access, tolerate, and process trauma in a broader sense of Presence Awareness.

Trauma Care doi: 10.3390/traumacare2040048

Authors: Crispin Rakibu Mbamba Jennifer Litela Asare Clinton Gyimah

When people move across borders to seek asylum because of violence, conflicts, persecution, or human rights violations, they experience a complex mix of psychological and traumatic downfalls. Often, refugees and asylum seekers’ trauma is compounded by the behaviours of individuals, communities, and the systemic climate of host countries. The United States is host to refugees and asylees from several countries. Evidence shows that several asylum seekers are held up in deplorable conditions in immigration detention centres where they are battling acute trauma. Therefore, consequent to this, coupled with the varying trauma that refugees face, this preliminary scoping review explores the scope and context of available peer-reviewed scholarship on trauma recovery pathways among refugees in the United States to identify gaps for further research. Following the PRISMA-compliant scoping review guidelines, we identified and curated data on the scope and context of peer-reviewed literature on trauma recovery approaches among refugees in the United States. This study identified the following as trauma recovery pathways among refugees: (1) macro-level structural intervention—preventing re-traumatization; (2) culturally sensitive therapeutic intervention; and (3) diagnosis and therapy. This study concludes that little research on the recovery pathways among refugees exists in the United States, hence the need for scholarship in this area.

Trauma Care doi: 10.3390/traumacare2040047

Authors: Lindsey Wylie Julie Garman Gaylene Armstrong Ashley Farrens Jennifer Burt Mark Foxall Michael Visenio Macall Cox Cynthia Hernandez Charity Evans Ashley Ann Raposo-Hadley

As little is known about the influence of COVID-19 on rates of violent crime, the purpose of this study is to examine violent injury captured by emergency department admissions and by law enforcement in a mid-sized midwestern city (Omaha, Nebraska) from January 2016 to December 2020. Although COVID-19 did not show a direct significant relationship, weeks during the COVID-19 period showed a marginal increase in incident rate ratios for violent incidents in both datasets. While violence remained stable during the pandemic, racial differences between samples were observed. This study emphasizes the utility of a transdisciplinary approach to understand the underlying drivers of violent crime and victimization.

Trauma Care doi: 10.3390/traumacare2040046

Authors: Laila Jeebodh-Desai Veronica M. Dwarika

Mindfulness and meditation was explored with the view to support the use of trauma-sensitive mindfulness (TSM) in clinical practice with survivors of war refugees in the treatment of post-traumatic stress disorders. The following questions were explored: (1) How are mindfulness and meditation defined? (2) What are the practices and perceived value of mindfulness practices? (3) What are the evidence and non-evidence-based treatments for post-traumatic stress disorder (PTSD)? (4) What are the possibilities of using TSM to support war-traumatised refugees in the treatment of PTSD in a refugee camp setting? Findings that measured currently actioned interventions for war-traumatised refugees did not account for psychological support that could be implemented in a refugee camp setting on a once-off basis. In response to the gaps and limitations highlighted, the study suggests an adaptation of the TSM intervention and professional development of practitioners in the art of TSM therapy.

Trauma Care doi: 10.3390/traumacare2040045

Authors: Jacob E. Milner Ean C. Schwartz Joseph S. Geller David Constantinescu Paul R. Allegra Justin E. Trapana Fernando E. Vilella

We report the case of a 20-year-old male who developed severe HO of the left hip secondary to a prolonged course of COVID-19 pneumonia. Upon extubation, he was found to have debilitating left hip pain and significant functional deficits with regard to his range of motion and functional status. There are numerous known causes of heterotopic ossification (HO), including trauma, surgery, and traumatic brain or spinal cord injuries. An increased incidence of HO has also been reported in patients who undergo prolonged intubation. While the COVID-19 virus has many known respiratory and medical complications, it has also resulted in unforeseen complications that present long-term challenges for patients. When treating patients with coronavirus, physicians should be aware of HO as a possible complication and consider it as a cause of musculoskeletal pain.