Risk factors and outcomes associated with post-traumatic headache after mild traumatic brain injury

This study aims to determine the prevalence and potential risk factors of acute and chronic post-traumatic headache (PTH) in patients with mild to moderate traumatic brain injury (TBI) | Emergency Medicine Journal

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Objectives: Acute PTH (aPTH) is defined by new or worsening of pre-existing headache occurring within 7 days after trauma, whereas chronic PTH (cPTH) is defined as persisting aPTH >3 months after trauma. An additional goal was to study the impact of aPTH and cPTH in terms of return to work (RTW), anxiety and depression.

Conclusions: PTH is an important health problem with a significant impact on long-term outcome of TBI patients. Several risk factors were identified, which can aid in early identification of subjects at risk for PTH.

Full reference: Tansel, Y. et al. (2017) Risk factors and outcomes associated with post-traumatic headache after mild traumatic brain injury. Emergency Medicine Journal. Published Online First: 8th July 2017

Management of major trauma

Trauma remains one of the leading causes of mortality and morbidity in the UK | Anaesthesia and Intensive Care Medicine

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Trauma is the primary cause of mortality in the first four decades of life and has a significant impact on the economy of the nation. In recent years the structure of trauma care has undergone significant restructuring. This article will review the reports that led to these changes, discuss the changes that have occurred and describe some of the anaesthetic management of this important group of patients.

Full reference: pearson, J. et al. (2017) Management of major trauma. Anaesthesia and Intensive Care Medicine. Published online: June 24, 2017

 

Prevalence of non-accidental trauma among children at ACS verified pediatric trauma centers

Child abuse remains a national epidemic that has detrimental effects if unnoticed in the clinical setting | Journal of Trauma and Acute Care Surgery

Background: Extreme cases of child abuse, or non-accidental trauma (NAT), have large financial burdens associated with them due to treatment costs and long-term effects of abuse. Clinicians that have additional training and experience with pediatric trauma are better equipped to detect signs of NAT and have more experience reporting it. This additional training and experience can be measured by using the American College of Surgeons (ACS) Pediatric Trauma Verification. It is hypothesized that ACS verified Pediatric Trauma Centers (vPTCs) have an increased prevalence of NAT due to this additional experience and training when relative to non-ACS vPTCs.

Conclusions: The greater prevalence of NAT at vPTCs likely represents a more accurate measure of NAT among pediatric trauma patients, likely due to more experience and training of clinicians.

Full reference: Bogumil, D.D.A. et al. (2017) Prevalence of non-accidental trauma among children at ACS verified pediatric trauma centers. Journal of Trauma and Acute Care Surgery: Published online: 20 June 2017

 

Ultrasound for children with abdominal trauma

Despite evidence showing that the routine use of sonography in hospital emergency departments can safely improve care for adults when evaluating for possible abdominal trauma injuries, researchers at UC Davis Medical Center could not identify any significant improvements in care for pediatric trauma patients | ScienceDaily

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The findings, which resulted from a randomized clinical study involving 925 children with blunt torso trauma who were evaluated in the emergency department at the medical center, showed no difference in important clinical outcomes. The outcomes assessed were developed for the study mainly based on previous research in injured adults.

The UC Davis team investigated the Focused Assessment with Sonography for Trauma (FAST) to determine whether the use of the FAST examination could safely lead to a decrease in the use of computed tomography (CT) scans for children, and other outcomes. FAST is a bedside ultrasound examination using a portable ultrasound machine. It has not been routinely used in the initial emergency department evaluations of injured children. CT scans represent the “gold standard” in diagnostic imaging for clinicians, including the identification of intra-abdominal injuries, but they also pose a greater radiation risk for children than they do for adults.

Resiliency and quality of life trajectories after injury

Zarzaur, B. et al. Journal of Trauma and Acute Care Surgery. Published online: 23 February 2017

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Background: Injury can greatly impact patients’ long-term quality of life. Resilience refers to an individual’s ability to positively adapt after facing stress or trauma. The objective of this study was to examine the relationship between pre-injury resiliency scores and quality of life after injury.

Conclusion: Patient resiliency predicts quality of life after injury in regards to mental health with over 25% of patients suffering poor mental health outcome trajectories. Efforts to teach resiliency skills to injured patients could improve long-term mental health for injured patients. Trauma centers are well positioned to carry out such interventions.

Read the full abstract here

Trauma and psychiatric disorders, a systematic review

Clous, E.A. et al. Journal of Trauma and Acute Care Surgery. Published online: 26 January 2017

Background: Suicide is currently a topic of high priority for policy-makers, researchers and clinicians. The World Health Organization estimated 804.000 suicide deaths worldwide in 2012. Some studies that focused on patients with self-inflicted injury revealed that mortality in this group is higher than for patients who sustain unintentional injury. However little is known about the impact of psychiatric disorders on health care resources including length of hospital stay.

Conclusion: Patients who have a psychiatric disorder or who have attempted suicide are at higher risk of increased in-hospital mortality and prolonged length of stay after sustaining injuries. These patients also tend to be at higher risk of complications after severe trauma, however future research is needed to confirm these potentially important implications.

Read the full abstract here

AHEAD Study: an observational study of the management of anticoagulated patients who suffer head injury

Mason, S. et al. (2017) BMJ Open. 7:e014324.

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Objectives: Management of anticoagulated patients after head injury is unclear due to lack of robust evidence. This study aimed to determine the adverse outcome rate in these patients and identify risk factors associated with poor outcome.

 

Conclusions: In alert warfarinised patients following head injury, the presence of symptoms is associated with greater risk of adverse outcome. Those with GCS=15 and no symptoms are a substantial group and have a low risk of adverse outcome.

Read the full abstract and article here