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Trauma Care, Volume 2, Issue 1 (March 2022) – 7 articles

Cover Story (view full-size image): Injuries arising from RTCs are major health problems in Saudi Arabia. This study aimed to determine the feasibility of conducting a multicenter study to explore factors that influence the mortality of RTC-related trauma patients in SA. A multicenter observational study was undertaken, with prospective and retrospective data collected from three hospitals. Being treated in a non-trauma center and having low SBP, low GCS, and high ISS scores were statistically significant independent predictors of 30-day in-hospital mortality following an RTC. Being an MV–driver, being admitted to the ICU, and having a head injury and/or thorax/abdominal injury were also linked to mortality. Collecting multicenter injury data in SA has logistic challenges predominantly associated with the comparability and completeness of datasets and the need for manual screening and data collection at some institutions. View this paper
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8 pages, 1238 KiB  
Article
Assessment and Management of Pain in Patients Sustaining Burns at Emergency Department Kenyatta National Hospital, Kenya: A Descriptive Study
Trauma Care 2022, 2(1), 79-86; https://doi.org/10.3390/traumacare2010007 - 01 Mar 2022
Cited by 2 | Viewed by 3893
Abstract
Background: Poorly managed burn pain affects the victim by delayed healing, psychological disturbances, and chronic pain. Burn injuries are the fourth leading cause of injuries worldwide. The incidence of thermal burns in Kenya is 3%. Pain assessment and control are integral parts of [...] Read more.
Background: Poorly managed burn pain affects the victim by delayed healing, psychological disturbances, and chronic pain. Burn injuries are the fourth leading cause of injuries worldwide. The incidence of thermal burns in Kenya is 3%. Pain assessment and control are integral parts of management that a burn victim should be offered. We lack data on pain management in burn patients during setup. Methods: A descriptive study was carried out at the emergency department (ED) of Kenyatta National Hospital. We enrolled patients who sustained thermal burns until a sample 138 patients was reached. Enrollment of patients was done from February to August 2015. The pain level was assessed using a visual analogue scale, and the Lund and Browder chart was used to record the depth and extent of the burn. Data on the type of analgesia prescribed and its route of administration was collected. Data was analyzed using STATA v.11. Results: The median age of the sample was 28 years with a male to female ratio 1.8:1. The majority of the victims (38%) sustained flame burns. The median total body surface area was 19.5%. Pain assessment was done in 2% with a visual analogue scale and face pain recognition scale. Mean Visual Analogue score was 7. Analgesia was offered to 96% of participants, and it was unimodal in the majority, 76.7%, and the preferred drug of choice was morphine. The majority of all burn patients had sustained moderate to major burns. The tools used to assess pain in this hospital were Face Pain Recognition Scale and Visual Analogue Scale; however, pain assessment was done on a meagre 2% of the sample. Conclusions: A minority of the patients had any sort of pain assessment done at the emergency department. As a result, burn pain was inappropriately managed. There is a need to improve the assessment of burn pain and improve its management by encouraging training of ED burn care providers by burn surgeons and pain therapists. Full article
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16 pages, 1383 KiB  
Systematic Review
The Role of Prehospital REBOA for Hemorrhage Control in Civilian and Military Austere Settings: A Systematic Review
Trauma Care 2022, 2(1), 63-78; https://doi.org/10.3390/traumacare2010006 - 25 Feb 2022
Viewed by 3574
Abstract
Despite the success of prehospital resuscitative endovascular balloon occlusion of the aorta (REBOA) in combat and civilian settings, the prevalence of complications and the lack of conclusive evidence has led to uncertainty and controversy. Therefore, this systematic review aimed to evaluate the role [...] Read more.
Despite the success of prehospital resuscitative endovascular balloon occlusion of the aorta (REBOA) in combat and civilian settings, the prevalence of complications and the lack of conclusive evidence has led to uncertainty and controversy. Therefore, this systematic review aimed to evaluate the role of prehospital REBOA for hemorrhage control in trauma populations. We systematically searched Cochrane, Ovid MEDLINE, EMBASE and Google Scholar for all relevant studies that investigated the efficacy of prehospital REBOA on trauma patients with massive hemorrhage. Primary outcome was evaluated by blood pressure elevation and secondary outcome was measured by 30-day mortality and complications. Our search identified 546 studies, but only six studies met the inclusion and exclusion criteria. Included studies were low to moderate quality due to limitations within the studies. However, all of the studies reported significant elevation of blood pressure and survival, demonstrating the potential benefits of REBOA. For example, the 30-day mortality rate reduced significantly after REBOA, but studies lacked long-term outcome assessments across the continuum of care. Due to the heterogeneity of the results, a meta-analysis was not possible. We conclude that prehospital REBOA is a feasible and effective resuscitative adjunct for shock patients with lethal non-compressible torso hemorrhage. However, due to the unclear causes of complications and the lack of high quality and homogeneous data, the effects of prehospital REBOA were not truly reflected and comparison between groups was not feasible. Thus, further high-quality studies are required to attest the causality between prehospital REBOA and outcomes. Full article
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12 pages, 596 KiB  
Review
A Scoping Review of Interventions Delivered by Peers to Support the Resettlement Process of Refugees and Asylum Seekers
Trauma Care 2022, 2(1), 51-62; https://doi.org/10.3390/traumacare2010005 - 25 Feb 2022
Viewed by 3830
Abstract
Background: Refugees and asylum seekers face many social and psychological challenges on their journey to resettlement in host countries. Interventions and programmes designed to assist in these challenges are necessary. The aim of this scoping review is to conduct a systematic search of [...] Read more.
Background: Refugees and asylum seekers face many social and psychological challenges on their journey to resettlement in host countries. Interventions and programmes designed to assist in these challenges are necessary. The aim of this scoping review is to conduct a systematic search of the literature as it pertains to interventions delivered by peers to refugees and asylum seekers during the resettlement process. Methods: A PRISMA-compliant scoping review was conducted. Four databases, Scopus, Embase, Ebsco, and ScienceDirect were searched for peer-reviewed articles published in English from 2000–2021. Studies were included if they reported on interventions, outcomes or the training received by adult peers to support refugees and asylum seekers during the resettlement process. Results: Of an initial 639 journal articles retrieved, 14 met the inclusion criteria for this review. Most included studies were conducted in Western high-income countries, except for one. Studies were heterogeneous in terms of the nationalities of peers and those receiving peer interventions; the outcomes reported on; the content of interventions; and the methodologies used. Conclusions: Findings suggest that peer interventions seem to be effective in addressing many of the challenges faced by refugees and asylum seekers. Community integration, acculturation and psychological distress are some of the key benefits. When such interventions are co-produced in participatory research involving refugees, asylum seekers, and the civil society organisations that support this population, they are naturally culturally responsive and can therefore address issues relative to different ethnic needs during the resettlement process. Full article
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16 pages, 297 KiB  
Article
Exploring Factors That Influence Injured Patients’ Outcomes following Road Traffic Crashes: A Multi-Site Feasibility Study
Trauma Care 2022, 2(1), 35-50; https://doi.org/10.3390/traumacare2010004 - 23 Feb 2022
Cited by 1 | Viewed by 2161
Abstract
Background: Injuries arising from Road Traffic Crashes (RTCs) are a major health problem in Saudi Arabia (SA). The purpose of the study was to determine the feasibility of conducting a multi-center research study to explore factors that influence the mortality of RTC-related trauma [...] Read more.
Background: Injuries arising from Road Traffic Crashes (RTCs) are a major health problem in Saudi Arabia (SA). The purpose of the study was to determine the feasibility of conducting a multi-center research study to explore factors that influence the mortality of RTC-related trauma patients in SA. Methods: A multi-center observational study was undertaken involving both prospective and retrospective data collected from three hospitals. In-hospital patient mortality thirty days post-crash was the primary outcome variable. The feasibility of the study methods including the quality of data were evaluated and pilot results pertaining to factors predicting mortality were examined. Results: The overall mortality rate (n = 572 RTC victims) was (7.5%). A logistic regression model identified four independent predictors of mortality following an RTC: treatment at a non-trauma center-based hospital, SBP ≤ 90 mmHg, GCS ≤ 8, and ISS ≥ 20. With respect to the assessment of the study method’s feasibility, missing data was problematic, especially for variables pertaining to crash characteristics and prehospital care. Conclusions: Collecting multi-center injury data in SA has logistic challenges, predominantly associated with the comparability and completeness of data sets as well as the need for manual screening and data collection at some institutions. Despite these limitations, this study has demonstrated the feasibility of a method that could be utilized in further large nationwide studies to understand and examine the factors that influence injured patients’ outcomes following RTCs. Full article
12 pages, 647 KiB  
Systematic Review
Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review
Trauma Care 2022, 2(1), 23-34; https://doi.org/10.3390/traumacare2010003 - 02 Feb 2022
Cited by 1 | Viewed by 3542
Abstract
Catastrophic haemorrhage accounts for up to 40% of global trauma related mortality and is the leading cause of preventable deaths on the battlefield. Controlling abdominal and junctional haemorrhage is challenging, especially in the pre-hospital setting or ‘under fire’, yet there is no haemostatic [...] Read more.
Catastrophic haemorrhage accounts for up to 40% of global trauma related mortality and is the leading cause of preventable deaths on the battlefield. Controlling abdominal and junctional haemorrhage is challenging, especially in the pre-hospital setting or ‘under fire’, yet there is no haemostatic agent which satisfies the seven characteristics of an ‘ideal haemostat’. We conducted a systematic search of Embase, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science to evaluate the feasibility and efficacy of three types of haemostatic devices. Participants included any trauma patient in a pre-hospital setting, perfused human cadavers, or healthy human volunteer simulations. The haemostatic devices reviewed were REBOA, iTClampTM, and four junctional tourniquets: AAJT, CRoC, JETT, and SJT. The SJT had the best user survey performance of the junctional tourniquets, and the four junctional tourniquets had an overall efficacy of 26.6–100% and an application time of 10–203 s. The iTClampTM had an efficacy of 60–100% and an application time of 10–60 s. REBOA had an efficacy of 71–100% and an application time ranging from 5 min to >80 min. In civilian and military trauma patients the use of junctional tourniquets, iTClamp, or REBOA, mortality varied from 0–100%. All of these studies were deemed low to very low in quality, hence the reliability of data presented in each of the studies is called into question. We conclude that despite limited data for these devices, their use in the pre-hospital environment or ‘under fire’ is feasible with the correct training, portable imaging, and patient selection algorithms. However, higher quality studies are required to confirm the true efficacy of these devices. Full article
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12 pages, 279 KiB  
Article
COVID-19 Pandemic: Influence of Gender Identity on Stress, Anxiety, and Depression Levels in Canada
Trauma Care 2022, 2(1), 11-22; https://doi.org/10.3390/traumacare2010002 - 09 Jan 2022
Cited by 4 | Viewed by 2700
Abstract
Background: This cross-sectional study explored variation of the prevalence of perceived stress, depression and anxiety among different self-identified gender identity groups in the Canadian population during the early stages of the COVID-19 pandemic. Methods: Anxiety, depression, and stress were assessed using the Generalized [...] Read more.
Background: This cross-sectional study explored variation of the prevalence of perceived stress, depression and anxiety among different self-identified gender identity groups in the Canadian population during the early stages of the COVID-19 pandemic. Methods: Anxiety, depression, and stress were assessed using the Generalized Anxiety Disorder 7-item (GAD-7) scale, Patient Health Questionnaire-9 (PHQ-9), and Perceived Stress Scale (PSS) respectively. Data were analyzed using one-way analysis of variance. Results: There were 8267 respondents to the online survey; 982 (12.0%) were male-identified, 7120 (86.9%) female-identified, and 92 (1.1%) identified as a diverse gender group. Prevalence rates for clinically meaningful anxiety (333 (41.7%), 2882 (47.6%), 47 (61.0%)), depression (330 (40.2%), 2736 (44.3%), 46 (59.7%)), and stress (702 (79.6%), 5711 (86.4%), 74 (90.2%)) were highest among respondents who self-identified as “other gender” followed by female-identified and then male-identified, respectively. There were statistically significant differences between gender groups for mean scores on GAD-7 (F (2, 6929) = 18.02, p < 0.001), PHQ-9 (F (2, 191.4) = 11.17, p < 0.001), and PSS (F (2, 204.6) = 21.13, p < 0.001). Conclusions: Gender identity differences exist in terms of the prevalence and severity of anxiety, depressive, and stress symptoms during the COVID-19 pandemic. This finding highlights the importance of incorporating self-identified gender identity in medical research, clinical practice, and policy. Full article
10 pages, 1370 KiB  
Systematic Review
The Impact of a Cervical Collar on Intracranial Pressure in Traumatic Brain Injury Patients: A Systematic Review and Meta-Analysis
Trauma Care 2022, 2(1), 1-10; https://doi.org/10.3390/traumacare2010001 - 26 Dec 2021
Cited by 1 | Viewed by 6684
Abstract
Purpose: Although the use of a cervical collar in the prehospital setting is recommended to prevent secondary spinal cord injuries and ensure spinal immobilization, it is not known what effects this has on raising intracranial pressure (ICP) in traumatic brain injury (TBI) patients. [...] Read more.
Purpose: Although the use of a cervical collar in the prehospital setting is recommended to prevent secondary spinal cord injuries and ensure spinal immobilization, it is not known what effects this has on raising intracranial pressure (ICP) in traumatic brain injury (TBI) patients. In the absence of studies measuring ICP in the prehospital setting, the aim of this study was to systematically review the data related to ICP changes measured after presentation at the hospital in patients who had arrived wearing cervical collars. Methods: We searched Medline (PubMed), Embase, CINAHL, and Google Scholar for studies that investigated in-hospital ICP changes in TBI patients arriving at the hospital wearing collars. Titles, abstracts, and full texts were then searched for inclusion in the study. A narrative synthesis, as well as a meta-analysis, was performed. Results: Of the 1006 studies identified, only three met the inclusion/exclusion criteria. The quality of the three included studies was moderate and the risk of bias was low. All three studies used the Laerdal Stifneck collar, but all studies showed an increase in ICP after application of the collar. A further three studies that measured ICP but did not fit the systematic search were also included due to low patient numbers. A meta-analysis of the pooled data confirmed a significant increase in ICP, although between the four studies, only 77 patients were included. The meta-analysis also confirmed that after removal of the collar, there was a significant decrease in ICP. Conclusions: Our study suggests that the use of a cervical collar increases ICP in TBI and head injury patients, which may have detrimental effects. However, due to the extremely low sample size from all six studies, caution must be exercised when interpreting these data. Thus, further high-quality research is necessary to unequivocally clarify whether cervical collars should be used in patients with TBI. Full article
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