Journal of Trauma Nursing最新文献

Background: Social determinants of health (SDOH) can impact recovery after traumatic injury, but specific social needs of firearm injury survivors have not been well documented.

Objective: The objective of this study was to document the resources provided to urban firearm injury survivors immediately after hospital discharge, highlighting their outpatient SDOH needs during recovery.

Methods: This was a retrospective cohort review of all firearm injury survivors seen at an outpatient clinic in a Midwestern, U.S. urban Level I trauma center, from November 2020 through October 2022. Patients were evaluated by the clinic's master's-level social worker, who conducted comprehensive biopsychosocial assessments and documented resources provided in routine care notes. The resources provided were abstracted from social work notes and grouped by SDOH domains.

Results: Of the 255 patients evaluated, most were young (32.1 years), Black (80.4%), and male (81.6%); 43.1% sustained severe injuries (Injury Severity Score ≥ 16). Most patients received at least one resource (74.5%). Over half of patients received a financial resource (53.7%), with the most common being Crime Victim Compensation assistance (40.0%). Housing or rent support was also common (22.4%).

Conclusion: Financial and housing assistance are the most frequently needed resources among urban firearm injury survivors. The SDOH assessments by social workers, combined with strong partnerships to provide resources, can help trauma centers promote comprehensive recovery after firearm injury.

Background/rationale: Existing literature on pediatric traumatic brain injury (TBI) transfers to higher-level trauma centers is limited. Most studies focus on inhospital mortality and neurosurgical intervention rates, often overlooking outcomes such as early discharge without neurosurgical intervention, intensive care unit length of stay, and discharge disposition.

Objectives: To assess the impact of transfer to a higher-level trauma center on clinical outcomes of pediatric severe TBI patients.

Methods: This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program database between 2017 and 2023 to evaluate pediatric trauma patients with isolated severe TBI transferred from lower-level to higher-level trauma centers. The primary outcome was the odds of discharge within 24 or 48 h without requiring neurosurgical intervention and rates of neurosurgical intervention. Secondary outcomes included emergency department and 24-h mortality, initial and repeat computerized tomography scan rates, intensive care unit length of stay, ventilator-free days, and discharge home.

Results: Of the 4,154 pediatric patients with isolated severe TBI, 1,723 (41.5%) were transferred, and 2,418 (58.2%) were not. Transferred patients had a 42% lower odds of discharge within 24 h without neurosurgical intervention (OR: 0.58, 95% CI [0.41, 0.80], p < .001), were more likely to undergo neurosurgical intervention (OR: 1.26, 95% CI [1.04, 1.53], p = .016), and were more likely to be discharged home (OR: 1.58, 95% CI [1.30, 1.92], p < .001). Mortality rates did not differ significantly between groups.

Conclusion: Transfer to higher-level trauma centers is associated with increased neurosurgical intervention and higher rates of discharge home in pediatric patients with severe TBI, without differences in mortality.

Background: Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in older adults, often necessitating tracheostomy for prolonged ventilation. The optimal timing of tracheostomy in severe TBI remains debated.

Objective: To compare clinical outcomes of early (≤7 days) versus late (>7 days) tracheostomy in older patients with isolated severe TBI.

Methods: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Participant Use File database from 2017 to 2023 to evaluate clinical outcomes of older trauma patients with isolated severe TBI treated with early (≤7 days) versus late (>7 days) tracheostomy placement.

Results: Of 1,565 older patients with severe TBI, 21.7% received an early tracheostomy and 72.5% a late tracheostomy. Early tracheostomy was associated with significantly shorter intensive care unit length of stay (ICU-LOS) (β= -7.26, 95% CI [-8.95, -5.58], p < .001), more ventilator-free days (β= 4.02, 95% CI [2.75, 5.29], p < .001), fewer ventilator days (β= -6.23, 95% CI [-8.05, -4.41, p < .001), and lower risk of ventilator-associated pneumonia (adjusted odds ratio, aOR = 0.37, 95% CI [0.18, 0.77], p = .008). No significant associations existed between tracheostomy timing and inhospital mortality (aOR = 1.13, 95% CI [0.64, 1.99], p = .670) or remaining complication rates.

Conclusion: Early tracheostomy within 7 days for older patients with severe TBI is a safe management option, with significantly decreased ICU-LOS and ventilation time, improved or comparable complication rates, and no significant increase in mortality rates compared to late tracheostomy.

Background: Early mobilization programs are crucial in enhancing burn patients' functional and psychosocial status, leading to greater independence and quality of life. However, there are no standardized guidelines for implementing these programs in burn centers.

Objective: This study aims to evaluate the effectiveness of an evidence-based early mobilization protocol in enhancing independent functioning and quality of life in burn patients.

Methods: In this randomized controlled trial, burn patients admitted to a 64-bed burn unit of a large tertiary hospital in Tabriz, East Azerbaijan, Iran, were enrolled from April 2021 to February 2022. Participants were randomly allocated to either the standard care (control group; n = 62) or the early mobilization (intervention group; n = 64). The intervention protocol, derived from contemporary burn nursing literature, was implemented in addition to routine care. Outcomes were measured using the Functional Independence Measure (FIM) and the Burn Specific Health Scale-Brief (BSHS-B) at discharge and 3-month follow-up.

Results: Of the 126 participants, 68 (53.9%) were male, 58 (46.1%) were female, and most (74%) had both partial and full-thickness burns. Baseline demographic and burn characteristics were similar between groups ( p > .05). At discharge, the intervention group had significantly higher FIM and BSHS-B mean rank compared to the control group ( p < .001). These differences remained significant at the 3-month follow-up ( p < .001).

Conclusion: The early mobilization program shows promise as a standard adjunctive therapy in burn treatment regimens, meriting further investigation and potential widespread adoption.

Background: Hospital-based violence intervention programs (HVIPs) effectively reduce recidivism and improve outcomes, but their impact on posthospitalization service utilization for patients with penetrating injuries is unclear.

Objective: The aim of this article is to evaluate the impact of an HVIP on posthospitalization service utilization among patients with penetrating injuries.

Methods: A retrospective cohort study was conducted at our urban academic Level I trauma center in the Northeastern United States to assess posthospitalization service utilization, including inpatient rehabilitation and home health services, among patients with gunshot or stab wounds during the first year of HVIP implementation (October 2022-September 2023). Comparisons between the HVIP and non-HVIP groups were made using Mann-Whitney U and Chi-square/Fisher's exact tests. Multivariate logistic regression evaluated predictors of posthospitalization service utilization.

Results: Of the 192 patients, 62 were HVIP, and 130 were non-HVIP. The HVIP patients were younger (31 vs. 35 years; p = .010) and more likely to be injured by gunfire (77.4% vs. 45.4%; p < .001), with a higher median Injury Severity Score (4 vs. 1; p = .029). Posthospitalization service utilization was significantly higher in HVIP patients (25.8% vs. 9.2%; p = .002). Predictors of posthospitalization service utilization included hospital admission (OR: 10.5, p = .033), Hispanic ethnicity (OR: 3.2, p = .035), and higher Injury Severity Score (OR: 1.2, p < .001). The HVIP involvement had a positive but nonsignificant association (OR: 2.5, p = .078).

Conclusions: Hospital-based violence intervention programs may increase posthospitalization service utilization and promote health equity for patients with penetrating injuries. Larger studies are needed to confirm these findings.

Background: Implicit biases and color blindness attitudes among health care providers negatively impact health outcomes and decision-making, particularly for marginalized trauma patients. While research highlights perspective-taking as a method to mitigate health care bias, effective educational strategies to reduce such biases among trauma care professionals remain understudied.

Objective: To evaluate the effectiveness of "A Brain Game: Deconstructing Bias" as an intervention for levels of perspective-taking and color blindness attitudes among trauma care professionals.

Methods: This is a single-center, prospective cohort survey study. Using a modified snowball sampling approach, participants were recruited and represented various trauma system roles, including clinicians, researchers, data analysts, social workers, and outpatient providers. Pre- and postintervention surveys assessed perspective-taking, color blindness attitudes, and willingness to consider bias.

Results: A total of 132 participants initiated a presurvey with a total of 58 (44%) participants completing both pre- and postintervention surveys included in the analysis. Statistically significant changes observed with increases in perspective-taking scores (p < .001), understanding social constructs (p < .001), alongside decreases in color blindness (p = .049), and unawareness of institutional racism (p = .020). Additionally, 82.8% (n = 48) of participants expressed a willingness to consider their biases before patient interactions.

Conclusion: This pilot study found that the theatrical intervention, "A Brain Game: Deconstructing Bias," improved trauma professionals' understanding of social constructs, enhanced perspective-taking, reduced color blindness attitudes, and increased willingness to consider bias in patient care. Despite its feasibility, moderate completion rates and single-center design limit generalizability. Further research is warranted.

Background: The low incidence of non-iatrogenic extremity vascular injuries in children, combined with the anatomical and physiological characteristics of children, poses challenges for diagnosis, operative treatment, and recovery. No national guidelines are available to inform the care of children with vascular injuries to the extremities.

Objective: The objective of this concise report is to describe the incidence and contributing mechanisms of injury resulting in pediatric extremity vascular trauma and summarize currently cited approaches for management.

Methods:

Data sources: English-language publications in PubMed and CINAHL that focus on extremity vascular injuries in children aged 0-17 years were reviewed.

Study selection: Publications from 2014 to the present were prioritized; however, as relevant research remains sparse, sentinel papers published before 2014 were also reviewed. Bibliographies from retrieved articles were also scanned. Retrospective studies, case studies, and single institution studies were included in the analysis.

Data extraction: Data were manually extracted from journal publications using established inclusion and exclusion criteria.

Results:

Data synthesis: A panel of pediatric trauma experts reviewed a total of 29 papers, seeking evidence-based methodology and brief summaries of the available literature.

Key themes: These injuries are rare, and the anatomical and physiological characteristics of pediatric vascular injuries mandate a multidisciplinary approach.

Conclusions: To minimize the consequences of extremity vascular injuries, successful treatment requires a high index of suspicion that allows for early diagnosis and prompt management. Clear recommendations regarding diagnosis and treatment are needed.