Articles: trauma.
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Chronic posttraumatic pain (CPTP) is common after traumatic stress exposure (TSE) and disproportionately burdens women. We previously showed across 3 independent longitudinal cohort studies that, in women, increased peritraumatic 17β-estradiol (E2) levels were associated with substantially lower CPTP over 1 year. Here, we assessed this relationship in a fourth longitudinal cohort and also assessed the relationship between E2 and CPTP at additional time points post-TSE. ⋯ In conclusion, peritraumatic E2 levels, but not those at post-TSE time points, predict CPTP in women TSE survivors. Administration of E2 immediately post TSE protects against mechanical hypersensitivity in female rats. Together with previous findings, these data indicate that increased peritraumatic E2 levels in women have protective effects against CPTP development and suggest that immediate post-TSE E2 administration in women could be a promising therapeutic strategy for reducing risk of CPTP.
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Nearly 30 million, mostly rurally-located Americans lack timely access to level I or II trauma center care, resulting in inefficient resource use and potentially preventable deaths. Although significant progress has been made in the care of the injured patient over the last few decades, rural trauma patients continue to face significant challenges in accessing high quality trauma care with resultant outcomes disparities and increased expenditures associated with potentially avoidable interfacility transfers. ⋯ While telehealth has been used in trauma with some success, it remains underused. Members of a 2023 ACS Committee on Trauma Spotlight Session on the role of teletrauma present an introduction to the applications, potential benefits and future directions for telehealth use in trauma care.
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Absence of pre-hospital coagulation tests challenges prompt management of hemostasis after trauma. The Viscoelastic Coagulation Monitor (VCM, Entegrion, Durham, NC) is a hand-held coagulation test for point-of-care. We evaluated VCM in a translational swine polytrauma model, hypothesizing that VCM correlates with a laboratory reference method, the TEG 5000 (Haemonetics, Boston, MA), and can identify coagulopathic phenotypes relevant to trauma. Our secondary hypothesis was that pre-warming of VCM disposable test cartridges using a heating plate versus pre-warming of cartridges by carrying the cartridge in the user's pocket does not significantly alter results. ⋯ In a trauma model, VCM detected significant changes in coagulation at point-of-care in a simplified portable form factor. VCM could enable informed hemostasis management in pre-hospital settings where coagulations tests are unavailable, pending further validation in clinical trials.
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Whole blood (WB) transfusion in trauma has been revisited, and recent studies have reported an association between WB and improved survival among patients with hemorrhagic shock. However, no evidence of a similar association exists for patients with hemorrhagic shock and traumatic brain injury (TBI). This study aimed to assess the association between WB and mortality among patients with hemorrhagic shock and TBI. ⋯ WB was not associated with reduced 30-day mortality among patients with hemorrhagic shock and TBI. These findings suggest that not all patients with hemorrhagic shock would benefit from WB.
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Journal of neurosurgery · Sep 2024
Novel application of latent class analysis to outcome assessment in traumatic brain injury with multiple injury subtypes or poly-TBI.
The aim of this study was to stratify poly-traumatic brain injury (poly-TBI) patterns into discrete classes and to determine the association of these classes with mortality and withdrawal of life-sustaining treatment (WLST). ⋯ Distinct poly-TBI classes were associated with increased in-hospital mortality and WLST. Further research with larger datasets will allow for more comprehensive poly-TBI class definitions and outcomes analysis.