Risultati per: Riabilitazione dopo un trauma traumatico

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

Objectives
To assess the validity of an International Classification of Diseases (ICD) code based definition of non-fatal head trauma caused by child abuse (abusive head trauma) for population surveillance in New Zealand.

Design
A retrospective cohort study of hospital inpatient records.

Setting
A tertiary children’s hospital in Auckland, New Zealand.

Participants
1731 children less than 5 years of age who were discharged after a non-fatal head trauma event over a 10-year period from 1 January 2010 to 31 December 2019.

Outcome measures
The outcome of assessment by the hospital’s multidisciplinary child protection team (CPT) was compared with the outcome of ICD, Tenth Revision (ICD-10) discharge coding for non-fatal abusive head trauma (AHT). The ICD-10 code definition of AHT was derived from an ICD, Ninth Revision, Clinical Modification definition developed by the Centers for Disease Control, Atlanta, Georgia, which requires both a clinical diagnosis code and a cause-of-injury code.

Results
There were 1755 head trauma events with 117 determined as AHT by the CPT. The ICD-10 code definition had a sensitivity of 66.7% (95% CI 57.4 to 75.1) and specificity of 99.8% (95% CI 99.5 to 100). There were only three false positives but 39 false negatives, with 18 of the false negatives coded with X59 (exposure to unspecified factor).

Conclusions
The ICD-10 code broad definition of AHT is a reasonable epidemiological tool for passive surveillance of AHT in New Zealand but it underestimates the incidence. Its performance could be improved by clear documentation of child protection conclusions in clinical notes, clarifying coding practice and removing the exclusion criteria from the definition.

Objective
In the UK there are around 5400 deaths annually from injury. Tranexamic acid (TXA) prevents bleeding and has been shown to reduce trauma mortality. However, only 5% of UK major trauma patients who are at risk of haemorrhage receive prehospital TXA. This review aims to examine the evidence regarding factors influencing the prehospital administration of TXA to trauma patients.

Design
Systematic literature review.

Data sources
AMED, CENTRAL, CINAHL, Cochrane Database of Systematic Reviews, Conference Proceedings Citation Index—Science, Embase and MEDLINE were searched from January 2010 to 2020; searches were updated in June 2022. Clinicaltrials.gov and OpenGrey were also searched and forward and backwards citation chasing performed.

Eligibility criteria
All primary research reporting factors influencing TXA administration to trauma patients in the prehospital setting was included.

Data extraction and synthesis
Two independent reviewers performed the selection process, quality assessment and data extraction. Data were tabulated, grouped by setting and influencing factor and synthesised narratively.

Results
Twenty papers (278 249 participants in total) were included in the final synthesis; 13 papers from civilian and 7 from military settings. Thirteen studies were rated as ‘moderate’ using the Effective Public Health Practice Project Quality Assessment Tool. Several common factors were identified: knowledge and skills; consequences and social influences; injury type (severity, injury site and mechanism); protocols; resources; priorities; patient age; patient sex.

Conclusions
This review highlights an absence of high-quality research. Preliminary evidence suggests a host of system and individual-level factors that may be important in determining whether TXA is administered to trauma patients in the prehospital setting.

Funding and registration
This review was supported by Research Capability Funding from the South Western Ambulance Service NHS Foundation Trust and the National Institute for Health Research Applied Research Collaboration South West Peninsula.

PROSPERO registration number
CRD42020162943.

Objectives
To evaluate the impact and feasibility of multisource feedback compared with traditional feedback for trauma team captains (TTCs).

Design
A mixed-methods, non-randomised prospective study.

Setting
A level one trauma centre in Ontario, Canada.

Participants
Postgraduate medical residents in emergency medicine and general surgery participating as TTCs. Selection was based on a convenience sampling method.

Intervention
Postgraduate medical residents participating as TTCs received either multisource feedback or standard feedback following trauma cases.

Main outcome measures
TTCs completed questionnaires designed to measure the self-reported intention to change practice (catalytic effect), immediately following a trauma case and 3 weeks later. Secondary outcomes included measures of perceived benefit, acceptability, and feasibility from TTCs and other trauma team members.

Results
Data were collected following 24 trauma team activations: TTCs from 12 activations received multisource feedback and 12 received standard feedback. The self-reported intention for practice change was not significantly different between groups initially (4.0 vs 4.0, p=0.57) and at 3 weeks (4.0 vs 3.0, p=0.25). Multisource feedback was perceived to be helpful and superior to the existing feedback process. Feasibility was identified as a challenge.

Conclusions
The self-reported intention for practice change was no different for TTCs who received multisource feedback and those who received standard feedback. Multisource feedback was favourably received by trauma team members, and TTCs perceived multisource feedback as useful for their development.

Introduction
Post-traumatic stress disorder (PTSD) symptoms in youth are influenced by parental anxiety and stress. When parents have high levels of stress or have developed PTSD themselves, children tend to show more anxiety symptoms. Parental stress can affect the severity of children’s PTSD and lower the success of recovery. However, the influence of parental stress on the effectiveness of trauma-focused therapies (eye movement desensitisation and reprocessing and cognitive behavioural therapy) has not yet been investigated to our knowledge. Hence, we will measure parental stress (using both validated scales and vocal acoustic markers) and investigate how it influences children’s PTSD recovery.

Method and analysis
Sixty children between the ages of 7 and 15 years who experienced type 1 trauma will be recruited at the Nice Pediatric Psychotrauma Center in France. We plan to measure stress using two different approaches. We will ask parents to answer validated scales of stress and mood in general. Stress will also be measured using vocal acoustic markers. Parents will be recorded while narrating their child’s trauma and during the narrative of a positive and neutral recall of events. Child participants will have to complete anxiety, PTSD and depression scales before the beginning of the trauma-focused therapy and after 3 months of treatment.
Linear mixed effects models and differential statistics, such as significance testing corrected for multiple testing, will be used to determine the validity of speech features for the proposed hypotheses. Repeated measures analysis of variance will be performed on the clinical scales scores according to parental stress. Correlations will be performed between clinical scales of parents and children according to time of assessment.

Ethics and dissemination
This study was approved by the Committee for the Protection of Individuals of the University of Nice Sophia Antipolis (CERNI) on 21 February 2022, under the number CER2022-015.
All participants will be informed that this is an observational study and their consent taken prior to the experiment. Participants will be informed that they can withdraw from the study at any time and that it would not affect the care provided.

Trial registration number
CER AVIS n° 2022-015.

Objectives
The aim is to compare adolescent (10–24.99 years) trauma patterns and interventions to adult (≥25) and paediatric cases (

Objectives
To evaluate the profile of non-urgent patients triaged ‘green’, as part of a triage trial in the emergency department (ED) of a secondary care hospital in India. The secondary aim was to validate the triage trial with the South African Triage Score (SATS).

Design
Prospective cohort study.

Setting
A secondary care hospital in Mumbai, India.

Participants
Patients aged 18 years and above with a history of trauma defined as having any of the external causes of morbidity and mortality listed in block V01–Y36, chapter XX of the International Classification of Disease version 10 codebook, triaged green between July 2016 and November 2019.

Primary and secondary outcome measures
Outcome measures were mortality within 24 hours, 30 days and mistriage.

Results
We included 4135 trauma patients triaged green. The mean age of patients was 32.8 (±13.1) years, and 77% were males. The median (IQR) length of stay of admitted patients was 3 (13) days. Half the patients had a mild Injury Severity Score (3–8), with the majority of injuries being blunt (98%). Of the patients triaged green by clinicians, three-quarters (74%) were undertriaged on validating with SATS. On telephonic follow-up, two patients were reported dead whereas one died while admitted in hospital.

Conclusions
Our study highlights the need for implementation and evaluation of training in trauma triage systems that use physiological parameters, including pulse, systolic blood pressure and Glasgow Coma Scale, for the in-hospital first responders in the EDs.

Objectives
To develop a core competency training curriculum system for emergency trauma nurses in China.

Design
A modified Delphi study design.

Participants
The selection criteria for participants identified in practitioner roles were to be currently engaged in trauma care for over 5 years, to serve as the manager of emergency or trauma surgery department, and to have a bachelor’s degree or higher. A total of 15 trauma experts from three grade A tertiary hospitals were invited to participate in this study by email or face to face in January 2022. The expert group comprised four trauma specialist doctors and 11 trauma specialist nurses. There were 11 women and 4 men. The age ranged from 32 to 50 (40.27±5.120) years. The number of years worked ranged from 6 to 32 (15.87±7.110).

Results
Two rounds of questionnaires were issued to 15 experts in each round, and the effective recovery rate was 100.00%. In this study, expert judgement=0.947, expert familiarity with the content=0.807 and authority coefficient=0.877, and the results are highly reliable. The Kendall’s W of the two rounds in this study ranged from 0.208 to 0.467, and the difference was statistically significant (p

Objective
Recent studies have shown that blood urea nitrogen to creatinine (BUN/Cr) ratio might be an effective marker for the prognosis of patients with respiratory diseases. Herein, we aimed to assess the association between BUN/Cr ratio and the risk of in-hospital mortality in patients with trauma-related acute respiratory distress syndrome (ARDS).

Design
A retrospective cohort study.

Setting and participants
1034 patients were extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) database.

Primary and secondary outcome measures
The primary outcome of the study was in-hospital mortality, defined by the vital status at the time of hospital discharge (ie, survivors and non-survivors).

Results
Of the total patients, 191 (18.5%) died in hospital. The median follow-up duration was 16.0 (8.3–26.6) days. The results showed that high level of BUN/Cr ratio was significantly associated with an increased risk of in-hospital mortality (15.54–21.43: HR=2.00, 95% CI: (1.18 to 3.38); >21.43: HR=1.76, 95% CI: (1.04 to 2.99)) of patients with trauma-related ARDS. In patients with trauma-related ARDS that aged ≥65 years old, male and female, Onychomycosis Severity Index (OSI) >98, Revised Trauma Score (RTS) >11, Simplified Acute Physiology Score II (SAPS-II) >37 and sequential organ failure assessment (SOFA) scores≤7, BUN/Cr ratio was also related to the increased risk of in-hospital mortality (all p

Comunicato del 26/04/2023 n°19

This randomized clinical trial examines whether systematic 4-factor prothrombin complex concentrate administration combined with a ratio-based transfusion protocol is superior to ratio-based transfusion alone in reducing 24-hour total blood product consumption in patients at risk of massive transfusion.

Introduction
Accurate and timely dispatch of emergency medical services (EMS) is vital due to limited resources and patients’ risk of mortality and morbidity increasing with time. Currently, most UK emergency operations centres (EOCs) rely on audio calls and accurate descriptions of the incident and patients’ injuries from lay 999 callers. If dispatchers in the EOCs could see the scene via live video streaming from the caller’s smartphone, this may enhance their decision making and enable quicker and more accurate dispatch of EMS. The main aim of this feasibility randomised controlled trial (RCT) is to assess the feasibility of conducting a definitive RCT to assess the clinical and cost effectiveness of using live streaming to improve targeting of EMS.

Methods and analysis
The SEE-IT Trial is a feasibility RCT with a nested process evaluation. The study also has two observational substudies: (1) in an EOC that routinely uses live streaming to assess the acceptability and feasibility of live streaming in a diverse inner-city population and (2) in an EOC that does not currently use live streaming to act as a comparator site regarding the psychological well-being of EOC staff using versus not using live streaming.

Ethics and dissemination
The study was approved by the Health Research Authority on 23 March 2022 (ref: 21/LO/0912), which included NHS Confidentiality Advisory Group approval received on 22 March 2022 (ref: 22/CAG/0003). This manuscript refers to V.0.8 of the protocol (7 November 2022). The trial is registered with the ISRCTN (ISRCTN11449333). The first participant was recruited on 18 June 2022.
The main output of this feasibility trial will be the knowledge gained to help inform the development of a large multicentre RCT to evaluate the clinical and cost effectiveness of the use of live streaming to aid EMS dispatch for trauma incidents.

Trial registration number
ISRCTN11449333.

Introduction
Sub-Saharan Africa has the highest rate of unintentional paediatric injury deaths. The Pediatric Resuscitation and Trauma Outcome (PRESTO) model predicts mortality using patient variables available in low-resource settings: age, systolic blood pressure (SBP), heart rate (HR), oxygen saturation, need for supplemental oxygen (SO) and neurologic status (Alert Verbal Painful Unresponsive (AVPU)). We sought to validate and assess the prognostic performance of PRESTO for paediatric injury patients at a tertiary referral hospital in Northern Tanzania.

Methods
This is a cross-sectional study from a prospective trauma registry from November 2020 to April 2022. We performed exploratory analysis of sociodemographic variables and developed a logistic regression model to predict mortality using R (V.4.1). The logistic regression model was evaluated using area under the receiver operating curve (AUC).

Results
499 patients were enrolled with a median age of 7 years (IQR 3.41–11.18). 65% were boys, and in-hospital mortality was 7.1%. Most were classified as alert on AVPU Scale (n=326, 86%) and had normal SBP (n=351, 98%). Median HR was 107 (IQR 88.5–124). The logistic regression model based on the original PRESTO model revealed that AVPU, HR and SO were statistically significant to predict in-hospital mortality. The model fit to our population revealed AUC=0.81, sensitivity=0.71 and specificity=0.79.

Conclusion
This is the first validation of a model to predict mortality for paediatric injury patients in Tanzania. Despite the low number of participants, our results show good predictive potential. Further research with a larger injury population should be done to improve the model for our population, such as through calibration.

Introduction
Orthopaedic trauma and fracture care commonly cause perioperative anaemia and associated functional iron deficiency due to a systemic inflammatory state. Modern, strict transfusion thresholds leave many patients anaemic; managing this perioperative anaemia is an opportunity to impact outcomes in orthopaedic trauma surgery. The primary outcome of this pilot study is feasibility for a large randomised controlled trial (RCT) to evaluate intravenous iron therapy (IVIT) to improve patient well-being following orthopaedic injury. Measurements will include rate of participant enrolment, screening failure, follow-up, missing data, adverse events and protocol deviation.

Methods and analysis
This single-centre, pilot, double-blind RCT investigates the use of IVIT for acute blood loss anaemia in traumatically injured orthopaedic patients. Patients are randomised to receive either a single dose infusion of low-molecular weight iron dextran (1000 mg) or placebo (normal saline) postoperatively during their hospital stay for trauma management. Eligible subjects include adult patients admitted for lower extremity or pelvis operative fracture care with a haemoglobin of 7–11 g/dL within 7 days postoperatively during inpatient care. Exclusion criteria include history of intolerance to intravenous iron supplementation, active haemorrhage requiring ongoing blood product resuscitation, multiple planned procedures, pre-existing haematologic disorders or chronic inflammatory states, iron overload on screening or vulnerable populations. We follow patients for 3 months to measure the effect of iron supplementation on clinical outcomes (resolution of anaemia and functional iron deficiency), patient-reported outcomes (fatigue, physical function, depression and quality of life) and translational measures of immune cell function.

Ethics and dissemination
This study has ethics approval (Oregon Health & Science University Institutional Review Board, STUDY00022441). We will disseminate the findings through peer-reviewed publications and conference presentations.

Trial registration number
NCT05292001; ClinicalTrials.gov.

Objective
The study purpose was to describe feasibility of implementation of the Reaching Out to Kids with Emotional Trauma (ROcKET) intervention. We hypothesised that the ROcKET Intervention would be feasible in a poor resource school.

Design
We performed a single-arm, single-centr feasibility study of an intervention pilot, based on the RE-AIM framework.

Setting
The intervention was delivered in a single K-4th elementary charter school in the Nashville, TN area, in a low-resource community.

Participants
57 elementary school children attending our partner school and reporting exposure to at least one adverse childhood experience (ACE) and their parents.

Interventions
The Reaching Out to Kids with Emotional Trauma (ROcKET) intervention is a school-based multilevel intervention (individual child, family and school) that promotes positive health behaviours in children who have been exposed to ACEs.

Outcomes
Outcomes were gathered qualitatively via focus groups. The primary outcome was feasibility. The secondary outcomes were implementation outcomes according to the RE-AIM framework, including Reach, Effectiveness, Adoption and Implementation.

Results
Of 105 eligible children, 57 children and their parents participated (54%) with 31 (54%) girls, 47 (82%) Black/African American, 5 (9%) Hispanic and 5 (9%) white. The school staff implemented all planned ROcKET sessions with >90% fidelity in each session, and 52 (91%) of children who completed the final intervention session went on to complete 6 month follow-up assessments. The average attendance at the in-school child sessions was 57 students (87%), and 35 (61%) of parents attended at least one family session, with 25 (44%) of parents attending at least half of the family sessions. 13 (23%) parents participated in the focus groups. Qualitative data suggested high parent participant satisfaction, uptake of positive health behaviours targeted by the intervention and increased quality of life.

Conclusions
Our study suggests that the ROcKET intervention was feasible and acceptably delivered in a local elementary school with high reach to low-income and minority populations. These data suggest that schools, especially those serving low-income and minority children, can be an appropriate avenue for interventions designed to address health disparities. Data from this study will be used to advise a pilot study of the intervention.