Articles: trauma.
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Uncontrolled hemorrhage is a leading cause of preventable death in trauma. Tourniquets (TQs) are commonly used to control bleeding in the prehospital setting, although their application is associated with risks. Therefore, this study aimed to identify complications arising from TQ use and to examine contributing risk factors. ⋯ This study found that a significant trauma in prehospital settings requiring TQ application is associated with a high rate of complications. Early complications, including local infections and compartment syndrome, were more frequent, whereas late complications like thromboembolism and muscle atrophy were less common. The findings suggest that factors such as the MOI and wound contamination may contribute to these complications, yet after applying multivariate regression, LOS and falls were the only variables found to be significantly associated with the development of complications. These findings underscore the need for further research comparing casualties with and without TQ application.
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Ballistic talus fractures are difficult to treat and there is a paucity of literature regarding the subject. The goal of the current study is to outline our experience and epidemiological findings from a single center with a large case series of ballistic talus fractures. ⋯ The current study offers a unique and previously unreported cohort of gunshot related talar fractures. Our deep infection rate of 4.8% was similar to other studies of closed talus fractures. We found an improvement in the average TDA for the operatively treated fractures, which may represent improvements in fracture reduction with operative fixation. Further studies with longer follow-up are necessary improve our limited understanding of these injuries and to enhance treatment.
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It has been suggested that intraspinal pressure (ISP) below the dura is elevated following traumatic spinal cord injury (TSCI). The dura can maintain the pressure, and hence a subdural compartment syndrome has been hypothesized to develop regardless of bony decompression. This study aimed to evaluate whether a such intradural compartment syndrome develops during the first 72 h in a porcine TSCI model. ⋯ These findings suggest that the subdural swelling of the spinal cord following thoracic TSCI is not responsible for the ISP increase measured in our TSCI model, but that the ISP increase was caused by the surgical procedure or the reconstitution of normal cerebrospinal fluid pressure.
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The American College of Surgeons now requires mental health screening and follow up for hospitalized patients in trauma centers. National estimates indicate that 20-40 % of these patients will develop posttraumatic stress disorder (PTSD) and/or depression within one year post-injury. Research has identified brief bedside screens that predict PTSD and depression post-discharge, such as the Injured Trauma Survivor Screen and Peritraumatic Distress Inventory. However, false negatives are common; almost a quarter of patients with a negative bedside risk screen may develop PTSD or depression post-discharge and may not receive appropriate follow up. As such, there is critical need to improve bedside risk-screening tools. We aimed to identify demographic, social, and trauma-related predictors of mental health symptoms among patients with negative bedside screens. ⋯ Findings suggest that risk-screening tools may be improved by including items that capture injury mechanism and social support. Alternatively, trauma centers should consider mental health referral for patients who have experienced violent trauma or have low levels of social support, even when bedside screening tools identify them as having low mental health risk.