Journal of Trauma Nursing最新文献

Objective: This systematic review aims to evaluate optimal early screening strategies, significant risk factors, and effective diagnostic and management approaches for delirium in critically ill geriatric surgical patients.

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

Study selection: Studies were included based on their relevance to early screening, risk factors, diagnostic accuracy, and management strategies for delirium in critically ill geriatric surgical patients. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data extraction: A total of 31 studies met the inclusion criteria. Outcomes of interest included effective early screening/prevention strategies, significant risk factors, sensitive diagnosis tools, and effective management strategies.

Data synthesis: Early screening strategies, including advanced neural networks and E-PROD-NS, demonstrated high sensitivity and specificity (area under the receiver operating characteristic curve >0.76). Key risk factors included advanced age, renal dysfunction, cognitive impairment, prolonged intensive care unit length of stay (ICU-LOS), and mechanical ventilation time. Diagnostic tools such as the 4A's test and serum biomarkers exhibited superior accuracy compared to the ICU Confusion Assessment Method and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Management strategies effectively reduced delirium duration, including acetaminophen, environmental modifications, and family involvement.

Conclusions: E-PROD-NS and the 4A's test were associated with early delirium detection and intervention. Risk factors for delirium included advanced age, renal dysfunction, and existing cognitive dysfunction. Mitigating mechanical ventilation and ICU-LOS duration, treatment with acetaminophen, and environmental modifications reduced delirium duration in critically ill geriatric surgical patients.

Registration: PROSPERO #CRD42025632279.

Background: Trauma nursing is fast-paced and high-pressure work that can affect nurses' physical and mental health. However, these effects remain unexplored among novice trauma nurses in a newly established trauma center in India.

Objective: To examine relationships between professional quality of life, sleep disturbances, anxiety, and resilience and to explore the experiences of novice trauma nurses in a newly established trauma center in India.

Methods: This sequential mixed-methods study was conducted between April and June 2024 in a newly established trauma center in India. A purposive sample of 80 nurses was surveyed using a demographic questionnaire, the Brief Resilience Scale, the Generalized Anxiety Disorder Scale, the Insomnia Severity Index, and the Professional Quality of Life Scale. Nine nurses were interviewed to explore their trauma experiences. The analysis included descriptive and inferential statistics, bootstrap-based mediation testing, and thematic content analysis.

Results: A total of 80 nurses completed the survey (response rate: 67.8%) with a mean age of 27.7 years (standard deviation [SD] = 2.89) and average years of trauma experience of 2.08 years (SD = 1.93). Higher compassion satisfaction correlated with fewer sleep disturbances (r = -.23, p = .037). Burnout positively correlated with anxiety (r = .24, p = .033) and sleep disturbances (r = .34, p = .023), and negatively with nurses' resilience (r = -.12, p = .049). Professional quality of life significantly correlated with resilience (r = .18, p = .048). Resilience mediated the relationship between anxiety and both burnout (β = .24, bootstrap confidence interval [BCI] = 0.04, 0.46, p = .041) and secondary traumatic stress (β = .24, BCI = 0.03, 0.52, p = .029). Qualitative analysis revealed three major themes: personal and professional adaptation to trauma life, adverse physical and psychological issues, and challenges faced in trauma care.

Conclusion: Our findings highlight the adverse impact of trauma nursing on sleep, resilience, anxiety, and professional quality of life among novice nurses in a newly established Level I trauma center in India. Targeted interventions are required to enhance resilience and mitigate the impact of caring for trauma patients.

Objective: This study aims to evaluate fluid resuscitation strategies including volume assessment measures, conservative versus aggressive fluid resuscitation, and multifocal fluid resuscitation protocols in critically ill geriatric trauma patients.

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

Study selection: Studies were included based on their relevance to volume assessment measures, conservative versus aggressive fluid resuscitation, and multifocal fluid resuscitation protocols in critically ill geriatric trauma patients.

Data extraction: A total of 14 studies met the inclusion criteria. Outcomes of interest included mortality, intensive care unit length of stay, ventilator days, and in-hospital complications.

Data synthesis: The initial query identified 1,257 studies, and after inclusion/exclusion criteria, a total of 14 studies were evaluated. On average, serum lactate levels above 2.5 mmol/L were found to be significantly associated with mortality. Conservative approaches to fluid resuscitation that were on average <1,500 cc were also found to decrease mortality and incur no increase in in-hospital complications. Additionally, goal-oriented geriatric fluid resuscitation protocols utilizing multiple measures for hemodynamic stability were found to reduce mortality in patients following the implementation of the protocol.

Conclusion: Serum lactate level kept on average below 2.5 mmol/L has shown to be an effective volume assessment measure and associated with decreased mortality. Additionally, conservative fluid resuscitation with volume maintained on average <15,000 cc was also associated with decreased mortality compared to aggressive fluid resuscitation measures. Lastly, goal-oriented geriatric fluid resuscitation protocols that aimed to maintain multiple volume assessment measures were associated with decreased mortality and complication rates. Implementation of these protocols has the potential to significantly improve outcomes in this vulnerable population.

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.