Journal of Trauma Nursing最新文献

Background: Delirium is a complication of the critically ill and is associated with poor outcomes. While delirium screening protocols exist for critically ill adults, standardized screening approaches remain lacking for pediatric patients.

Objective: This study aims to evaluate a multicomponent delirium initiative's effectiveness in screening compliance and to identify risk factors for delirium in pediatric trauma patients.

Methods: This pre- and postintervention study was conducted at an urban Level I pediatric trauma center in western Pennsylvania, wherein critically ill children, ages 0 months to 18 years, admitted to the pediatric intensive care unit with traumatic injuries in 2020 and 2021 were screened for delirium using the Cornell Assessment of Pediatric Delirium tool. Interventions included nurse and physician education, screening tool relocation in the electronic health record, delirium score discussions during bedside rounds, and audits with real-time feedback.

Results: A total of 482 patients were included in the analysis, of which 13 (2.7%) were diagnosed with delirium; 9 (69%) had a head injury. Children with delirium were older, had greater Injury Severity Scores (26 [17-29] vs. 13 [9-21], p = .001), and had a greater likelihood of blood transfusion. Delirium screening compliance increased from 20% preintervention to 68% postintervention. Delirium was associated with increased intensive care unit length of stay and discharge to inpatient rehabilitation.

Conclusion: This multicomponent delirium intervention in pediatric trauma increased delirium screening rates and found that delirium is associated with increased length of stay and discharge disposition.

Background: Trauma survivors often develop psychological sequelae, namely depression and post-traumatic stress disorder. Identifying and treating at-risk patients in rural trauma centers is challenging due to resource limitations, a gap not previously addressed in the literature.

Objective: To assess the feasibility and impact of a mental health screening initiative in a rural trauma center.

Methods: This quality improvement study used a quasi-experimental design to evaluate the feasibility and impact of a mental health screening initiative over 2 years (2022-2024) in a rural Northwestern U.S. Level II trauma center. We compared screening compliance, resource provision, and psychiatric consultation rates between the implementation (August 2022-July 2023) and post-implementation years (August 2023-July 2024). The inclusion criteria included trauma patients aged ≥18 years, with a Glasgow Coma Scale > 14, and who were admitted ≥ 2 days. The target screening compliance rate was set at ≥ 80%.

Results: Of the 1,114 eligible patients, 938 (84.2%) were screened, with 314 (33.5%) screening positive for psychological sequelae. All positive screen patients received a resource pamphlet and psychiatric consultation offers, resulting in 34 (10.8%) receiving formal evaluations. Missed screening opportunities decreased from 20.5% (95% CI [16.7, 24.4]) in the implementation year to 13.6% (95% CI [9.0, 18.2]) (p = .022) in the post-implementation year.

Conclusion: Mental health screening proved feasible in a rural trauma center, achieving 84.2% screening compliance. Despite barriers of limited staff availability and manual documentation, missed screening opportunities decreased. However, with only 10.8% of positively screened patients receiving psychiatric consultations, substantial systemic barriers remain to be addressed.

Background: Physical restraints are linked to adverse patient outcomes, yet there is limited research examining effective strategies to reduce restraint use in trauma intensive care units.

Objective: This study aims to assess the impact of a multicomponent physical restraint reduction initiative on restraint use in trauma intensive care unit patients.

Methods: This quality improvement project used a survey and a pre- and post-intervention methodology. The study compared restraint data from matching four-month periods in 2023 and 2024 in an 885-bed level I trauma center intensive care unit in the Southeastern United States. The study inclusion criteria were adult trauma patients (age > 18) and intensive care unit registered nurses. The exclusion criteria included pediatric patients and those requiring physical restraints for violent behavior. The project was conducted in five phases: (1) baseline staff survey of restraint use perceptions, (2) targeted education on restraint reduction strategies, (3) comparison of pre- and post-intervention restraint hours, (4) follow-up staff perception survey, and (5) analysis of restraint episodes and duration to measure impact.

Results: In total, 40 clinical staff completed the surveys, and 422 patient physical restraint episodes totaling 6,606 physical restraint hours were reviewed. Compared to the same four-month period in 2023, restraint hours decreased by 13.9%, and restraint episodes decreased by 16.6% in 2024.

Conclusion: This study of a multicomponent physical restraint reduction initiative reduced physical restraint use by identifying common barriers to proper application and educating staff on alternative measures. The intervention resulted in fewer restraint episodes and decreased total restraint hours.

Background: Hemorrhagic shock management includes controlling bleeding and blood product replacement; however, vasopressor therapy may be required to maintain adequate perfusion. Studies have shown the potential benefits of early vasopressin use, but there is limited evidence of its clinical utility.

Objective: This study aims to evaluate the efficacy of early vasopressin administration in trauma patients with refractory hemorrhagic shock.

Methods: This retrospective cohort study included adult trauma patients who received more than one blood product. The primary outcome was 28-day alive and vasopressor-free days. Secondary outcomes included blood product administration, 28-day alive and ventilator-free days, and intensive care unit and hospital length of stay (LOS). Safety outcomes included the incidence of renal replacement therapy, venous thromboembolism, and fluid overload.

Results: Overall, 37 patients were included, with seven (19%) in the vasopressin group and 30 (81%) in the norepinephrine group. The study population included primarily male patients (n = 29, 78%) with blunt injuries (n = 24, 65%) and a median Injury Severity Score of 26 [IQR 17.0-34.0]. There was no difference in the primary outcome between the vasopressin and norepinephrine groups (median 25.5 [IQR 22.7-26.7] vs 26.2 days [IQR 22.7-26.7], p = .985). All secondary and safety outcomes were similar, except that the vasopressin group was associated with a longer hospital LOS (20 [IQR 18-27] vs. 13 days [IQR 8-20], p = .036).

Conclusion: Early vasopressin administration was not associated with a significant difference in 28-day alive and vasopressor-free days. However, this study was limited by its small sample size, and further studies are needed.