Journal of Trauma Nursing最新文献

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.

Objective: This review aims to evaluate protocols for handoff and transition of care (HToC) in critically ill surgical patients, focusing on intervention strategies, provider's feedback, clinical outcomes, and barriers to effective HToC.

Data sources: A comprehensive search was conducted across five databases: PubMed, Google Scholar, ProQuest, Embase, and Cochrane.

Study selection: Studies assessing HToC protocols and interventions in critically ill adult surgical patients were included.

Data extraction: Twenty-nine articles were reviewed, encompassing over 3,920 handoffs and 746 provider interviews. Outcomes included effectiveness of intervention strategies, staff feedback, clinical results, and barriers to successful handoffs.

Data synthesis: Standardized checklists and structured workflows were the most frequently used strategies. These interventions significantly reduced handoff time and information omissions. Provider satisfaction and compliance improved, while preventable complications including drug dosing errors, allergic reactions, and pressure ulcers decreased. The most common barriers were poor communication, inconsistent provider participation, and time constraints.

Conclusion: Implementation of standardized HToC protocols in critically ill adult surgical patients reduces information omissions and preventable complications while improving provider satisfaction. These findings underscore the value of structured HToC protocols and the need for further research into their sustainability and long-term outcomes.

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: 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: 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.

Background: Venous thromboembolism (VTE) following solid, blunt, isolated abdominal organ injuries remains a common posttrauma complication in adults. Accordingly, gaining a better understanding of the effect of early versus late VTE prophylaxis to reduce rates of this complication is prudent.

Objective: The purpose of this study is to evaluate the impact of early versus late VTE prophylaxis on clinical outcomes in adult trauma patients with isolated blunt solid abdominal organ injuries.

Methods: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Program Participant Use File database between 2017 and 2021 to compare clinical outcomes between early (≤48 hours) and late (>48 hours) VTE prophylaxis, including deep vein thrombosis (DVT), pulmonary embolism (PE), and other secondary outcomes. This study included adult (age ≥ 16) trauma patients with severe (ISS > 15) and isolated Abbreviated Injury Scale (AIS) abdomen ≥ 3, all other body regions < 3, blunt American Association for the Surgery of Trauma (AAST) grade ≥ 3 solid abdominal organ injuries without traumatic brain injury (TBI) (AIS head < 2) who received early or late chemical VTE prophylaxis.

Results: A total of 3,365 non-TBI patients with isolated blunt solid abdominal organ injuries, with 2,033 patients (60.4%) receiving early VTE prophylaxis and 1,332 (39.6%) receiving late prophylaxis, were included. Early prophylaxis was associated with a 57% lower risk of DVT (OR 0.4, 95% CI [0.19, 0.98], p = .044).

Conclusion: Adult non-TBI trauma patients with isolated, moderate-severe, blunt solid abdominal organ injuries receiving early VTE prophylaxis have significantly lower odds of developing specifically DVT compared to patients receiving late prophylaxis.

Background: Blunt cerebrovascular injury (BCVI) is a rare but serious trauma complication linked to high stroke risk and mortality, often presenting without symptoms and delaying diagnosis. Despite known risk factors, data remain limited on outcomes, especially in patients with concurrent traumatic brain injury (TBI). Additionally, optimal management strategies, particularly for high-grade injuries, remain unclear.

Objective: The purpose of this study is to evaluate the incidence of BCVI, the associated risk factors, and outcomes for patients with BCVI with or without TBI to improve overall prognosis and outcomes in this patient population.

Methods: This retrospective cohort analysis utilized the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2017-2021). The study population included adult (age ≥ 16 years) blunt trauma patients with Injury Severity Score (ISS) of ≥ 9 and severe isolated (Abbreviated Injury Scale [AIS] head and neck ≥ 3, all other regions < 3) BCVI. Patients were then stratified based on the presence or absence of concomitant mild-moderate TBI (AIS head ≤ 2). Clinical outcomes were compared between BCVI and non-BCVI patients, including incidence of ischemic stroke, mortality rate, intensive care unit length of stay, ventilator-free days, and BCVI risk factors such as cervical spine fracture, mandibular fracture, basilar skull fracture, and presenting Glasgow Coma Scale (GCS) ≤ 8.

Results: Of 2,172 patients with isolated BCVI, 1,262 (58.1%) had carotid artery injuries and 910 (41.9%) had vertebral artery injuries. Among non-TBI patients, BCVI was significantly associated with cervical spine fractures (OR: 11.60, p < .001), mandibular fractures (OR: 2.87, p < .001), GCS ≤ 8 (OR: 1.65, p = .001), and ischemic stroke (OR: 19.32, p < .001). Among TBI patients, BCVI was significantly associated with cervical spine fractures (OR: 6.79, p < .001), mandibular fractures (OR: 2.10, p < .001), and ischemic stroke (OR: 40.67, p < .001).

Conclusions: Patients with BCVI had significantly higher odds of presenting with cervical spine and mandibular fractures in addition to ischemic stroke compared to those without BCVI. Understanding the risk factors for BCVI can help guide further investigations and support prompt diagnosis, optimizing care, and improving patient outcomes.