Journal of Trauma Nursing最新文献

Background: Non-battle injuries significantly impact military readiness and individuals' quality of life, yet research on their effects on soldiers remains inadequate.

Objective: This study examines relationships between non-battle injury characteristics, perceptions, health-related quality of life (HRQOL), and service capability in the Israel Defense Forces.

Methods: This retrospective cohort study assesses relationships between injury characteristics, perception, HRQOL, and service capability among active duty soldiers at an Israel Defense Forces clinic over 12 months (February 2023-February 2024).

Results: Among 85 participants, predominant injuries occurred from falls/jumps (30.6%) and sports/training (23.5%), mainly affecting lower limbs (44.7%), upper limbs (24.7%), and back/spine (11.8%). Primary diagnoses included blunt contusions (20%) and fractures (18.8%). Lower-limb injuries were associated with mobility difficulty, upper-limb injuries with self-care difficulty, and blunt contusions with improved HRQOL. Injury perception was negatively correlated with HRQOL, while penetrating injuries, particularly open cuts/wounds, were linked to reduced military service capability.

Conclusion: This first comprehensive analysis of non-battle injuries in the Israel Defense Forces reveals key associations between injury characteristics, perceptions, HRQOL, and service capability. Findings highlight the need for early detection and targeted intervention to preserve soldiers' well-being and performance.

Background: Level I trauma centers are required to screen at-risk patients for mental health concerns and provide appropriate intervention and referral. However, there is limited guidance on implementing these recommendations in the pediatric trauma population.

Objective: This study aims to evaluate a multicomponent initiative to improve mental health referral and follow-up in pediatric trauma patients.

Methods: We conducted a retrospective cohort study evaluating a multicomponent initiative aimed at improving mental health referral and follow-up in admitted pediatric trauma patients aged 8-17 years with a positive inpatient mental health screen. The study was conducted in a Level I pediatric trauma center in the Southern United States between December 2022 and March 2024. Outcomes included the provision of inpatient resources and outpatient follow-up.

Results: A total of N = 120 patients were included, of which 77 (64.2%) received a clinic appointment. Patients who had an inpatient social work consultation (n = 69, 89.6%, p = .023) or were discharged from the trauma service (n = 24, 55.8%, p = .002) were more likely to receive a clinic appointment. Of those scheduled, 51 (66.2%) attended their appointment. Factors associated with appointment adherence included White race (n = 32, 62.7%, p = .034) and higher Injury Severity Score (21.6 vs. 15.2, p = .010). Among attendees, over 50% of patients and 20% of parents continued to screen positive for posttraumatic stress, with 67% receiving mental health resources or referrals.

Conclusions: Our screening and resource provision process effectively identifies pediatric trauma patients at risk for psychosocial distress. However, improvements are needed to enhance referral completion and ensure follow-up care.

Background: Pediatric trauma patients are often exposed to treatments that can result in pain, fear, and anxiety. While nonpharmacological distraction techniques like stress balls have been increasingly used in pediatric care, their effectiveness during casting procedures remains unexplored.

Objective: This study aims to evaluate the impact of stress ball distraction on fear and anxiety in pediatric extremity fracture patients during casting procedures.

Methods: This randomized controlled trial, with a parallel group design, was conducted from February to May 2023 in a hospital in Erzurum, Turkey, to evaluate stress ball distraction on fear and anxiety in children aged 6-12 years presenting to the emergency department with extremity fracture.

Results: Among 66 children randomized to the stress ball (n = 33) or control (n = 33) group during casting procedures (mean age 8.5 years, 47% female), both groups were comparable at baseline. The stress ball group showed decreased fear scores (mean [SD], 2.24 [1.25] to 1.30 [1.07], p < .001), while controls showed increases (2.42 [1.02] to 3.15 [1.08], p < .001). State anxiety scores decreased in the stress ball group (mean [SD], 4.97 [2.52] to 3.09 [1.79], p < .001) but remained unchanged in controls (3.93 [0.32] to 3.91 [0.29], p = .487).

Conclusion: Our findings show that stress ball distraction reduced fear and anxiety in children during the casting procedures and is an easy and cost-effective intervention.

Background: Tiered trauma activation protocols help physicians prioritize the severely injured but may delay care for those with less severe injuries. While trauma nurse clinicians (TNCs) have been shown to provide efficient trauma care, their impact as primary responders for Level III trauma activations has not been studied.

Objective: This study aims to evaluate the impact of TNC response to Level III trauma activations on patient outcomes.

Methods: This pre- and postintervention study was conducted at a Midwestern United States Level I trauma center from July 1, 2023, to October 10, 2023, and included adult and pediatric trauma patients. In July 2022, we implemented a protocol where TNCs replaced physicians responding to Level III trauma activations. Data from the trauma registry and electronic medical records were analyzed before and after implementation. The primary outcome was time to computed tomography within 30 minutes. Secondary outcomes were emergency department (ED) time, hospital length of stay (LOS), and 30-day readmissions.

Results: The final analysis included 812 post-intervention patients (562 with TNCs, 250 without TNCs), of which 53% were male. Groups were comparable in age and Injury Severity Score at baseline. Patients seen by TNCs were more likely to receive computed tomography (CT) within 30 minutes (56% vs 35%, p < .0001), while ED and hospital LOS and readmission rates showed no significant difference between groups.

Conclusions: This study showed that trauma nurse clinicians' response to third-tiered activations is feasible and improves timely access to CT within 30 minutes, but it showed no effect on ED time, hospital LOS, or hospital readmissions.

Background: Ultrasound-guided fluid management is increasingly used in the intensive care unit, yet it's benefits in septic shock remains unknown.

Objective: To evaluate the use of critical care ultrasound for individualized volume management in septic shock patients.

Methods: A single-center, randomized controlled, prospective study was conducted on patients with septic shock admitted to the intensive care unit in Xi'an Daxing Hospital, Xi'an City, China, from September 2022 to December 2023. Upon intensive care unit admission, the patients were resuscitated according to the latest sepsis and septic shock guidelines and early goal-directed therapy. The study group additionally underwent critical care ultrasound examination to monitor and guide the adjustment of fluid resuscitation in real-time. The two groups' physiological and biochemical indexes and prognoses were compared before (T0) and 6 hours after (T6) fluid resuscitation.

Results: A total of 113 patients with septic shock were selected and randomly allocated into study (n = 57) and control (n = 56) groups. The central venous oxygen saturation, heart rate, mean arterial pressure, blood lactate, and lactate clearance rate of the two groups at T6 were significantly improved compared to T0 (P < .05). At T6, the study group's blood lactate was significantly lower and the lactate clearance was significantly higher than the control group (P < .05). At T6, the incidence of pulmonary edema, incidence of left heart failure, Sequential Organ Failure Assessment (SOFA) score and length of the intensive care unit hospitalization in the study group were significantly lower than the control group (P < .05).

Conclusion: The application of critical care ultrasound improved the outcome and helped guide individualized management of patients with septic shock.