Current Trauma Reports

This provides up-to-date epidemiology of adolescent suicide and risk factors for suicide and highlights the overlap of risks for suicide and injury. It reviews signs and symptoms, and the up-to-date evidence on screening for depression, post-traumatic stress disorder (PTSD), suicide, substance abuse, and lethal means, and offers strategies of implementation in trauma centers. The incidence of adolescent suicide has continued to rise in the USA to 6.5 per 100,000, with notable racial disparities. The risk factors are complex, but many pre-existing risk factors and sequela after injury such as exposures to violence, suicidal behaviors, substance abuse, depression and post-traumatic stress disorder, and specific injuries including traumatic brain injury and spinal cord injury have further emerged as risks. Studies show rates of suicidality as high as 30% in the acute care setting. There are short screening instruments that can be used to universally screen for depression and suicidality in adolescent trauma patients. Step-up models of care for PTSD are promising to increase screening and services after injury. Lethal means counseling, secure firearm storage practices, and firearm safety policies can reduce the risk of suicide. Suicide is the second leading cause of death in US adolescents, and trauma patients have significant risk factors for mental illness and suicidality before and after injury. Trauma centers should strongly consider screening adolescents, establish strategies for mental health support and referrals, and provide lethal means counseling to help prevent suicide.

The number of refugees across the globe continues to grow, leaving a large proportion of the global population in a vulnerable state of health. However, the number of robust clinical interventions has not kept apace. This paper provides a general review of literature on the trauma and violence that refugees face, the impact on health outcomes, and some of the promising models for clinical intervention. Refugees experience a cycle of trauma, violence, and distress that begins before migration and continues during migration and after resettlement. It has been challenging to develop robust clinical interventions due to the cumulative and cyclic effects of trauma, as well as the unique experiences of trauma that each refugee community and each refugee individual faces. Trauma-informed care is a critical component of health care. Developing stronger guidelines for trauma-informed care will help clinicians better provide inclusive and equitable care for refugee patients.

Management of the pediatric burn patient involves a careful, multi-faceted approach in order to meet treatment goals. Due to advances in surgical and medical care, mortality and morbidities can be minimized. This chapter seeks to address current advances which allow practitioners to provide excellent systemic care. Judicious fluid management of children with severe burn injury can improve the respiratory outcome measures of these children. A multi-modal approach to pain and sedation can improve the neurologic status of severely burned children. Children with significant burn injury can have the most favorable outcomes when the principles of skillful critical care are applied. Systemic critical care based on the best evidence available not only improves survival rates but also improves quality of life for these delicate patients.

To describe 4 primary areas of trauma experienced by black transgender women, resilience demonstrated by the community, and opportunities for trauma surgeons to better serve this community. Transphobia, racism, and misogyny place black transgender women at high risk for mistreatment in the workplace, criminal legal system, and community spaces. These experiences of social exclusion and trauma facilitate social isolation and reduced engagement with necessary services, like healthcare. Furthermore, many black transgender women do not seek care due to experiences of racial and gender microaggressions. As such, it is necessary that medical professionals who engage this community provide culturally responsive care. Black transgender women seeking care will likely present after having experienced significant social rejection as well as mental and physical traumas. Accordingly, medical professionals who engage them must be considerate of the impacts of their unique experiences when providing them care.

This review focuses on the decision making in lower extremity amputations with a special focus on the impact of microvascular techniques and bone regeneration options. In patients with severe extremity injuries, the decision to amputate critical and sustain a severe impact on the further quality of life. While inevitable in certain situations, more and more effort has been taken to try and salvage limbs, and algorithms were developed to facilitate the decision making process. The progresses in microsurgery as well as tissue engineering challenge the decision making processes and the algorithms towards limb salvage. Since the first replantation in 1962 and the development of microsurgery in the 1970s, countless body parts have been reattached leading to growing awareness in the medical community as well as the population about this possibility. The rates of major amputation declined in the years following the diffusion of distal bypass surgery. The downwards trend of the reconstructive ladder of treatment of soft tissue damages shows a better understanding of lower leg vascular anatomy and improved use of wound care technology. With deeper understanding of translational cellular biology, non-union treatment experienced a big step forward with the use of mesenchymal stem cells. With the RIA device, harvesting of autologous bone marrow became easier, and new treatment options of non-unions or osteomyelitis rose. This review highlights and compares scoring and algorithm systems that try supporting the decision process for amputation. It further discusses the current developments in treatments of non-unions and the role of microsurgery prior and during the amputation process.

This review explores ongoing efforts to document the global burden of surgical disease. The chapter recaps the theoretical basis for surgical disease burden measurement. It then focuses on the indirect and direct epidemiology of surgical disease throughout the world, with a particular focus on global and low- and middle-income country (LMIC) work. This review will focus on the results of peer-reviewed publications concerning surgical burden epidemiology from the last 5 years. It will demonstrate the multiple attempts to define which surgical conditions should be treated to meet high unmet needs for surgical care. It will also describe the results of modeling, field epidemiology, and alternate methods for assessing global, regional, and country burdens of surgical disease. Many people in the LMICs live without access to sufficient surgical care. Research from the past 5 years has begun to define this unmet need.

This review focuses on the recent evolution of the initial resuscitation of combat-injured personnel. It summarizes the recommendations of TCCC and makes recommendations based on literature review and author experience. Over nearly 20 years, the experience in caring for combat casualties in the global war on terror has led to significant changes within military trauma care. Evolution of pre-hospital care, utilization of tourniquets and TXA for hemorrhage control, and use of whole blood as the preferred resuscitative fluid have significantly reduced mortality. Additionally, the collective wisdom of experienced trauma surgeons serves as an invaluable guide for managing setup and flow within the various levels of the military trauma system. This review article highlights recommended practices for the initial resuscitation of personnel injured in combat along with providing proven methods for trauma team preparation and management that can and should be used by any surgeon preparing to deploy.

Elderly trauma patients (≥65 years) account for 12% of trauma admissions, and trauma represents the fifth leading cause of death in this population. Critically ill elderly patients are among the most complex population to optimize medications. This review will discuss pharmacokinetic and pharmacodynamic considerations in older ICU patients based on physiologic changes related to aging. Drug therapy plays a key role in improving outcomes after critical illness. Consideration of potential adverse events is important when selecting pain and sedation regimens in elderly ICU patients. Recent studies have shown that non-pharmacologic interventions, such as early mobilization or the avoidance of benzodiazepines, are associated with a decreased incidence of delirium. When prescribing antimicrobial agents, pharmacodynamic principles should be considered to achieve the ideal therapeutic response. Further pharmacologic studies are required to help to delineate the pharmacokinetic/pharmacodynamic differences in the elderly trauma population.

The incidence of traumatic injury to the thorax is estimated at up to 40 % of patients that require hospitalization. The vast majority of these injuries can be managed with observation. However, the presence of pneumothorax or hemothorax has traditionally mandated tube thoracostomy placement and the inherent morbidities that may arise. Persistent pneumothorax is typically defined as the presence of pneumothorax and/or air leak for 5–7 days after tube placement. This morbidity may be managed expectantly or with video-assisted thoracoscopic surgery (VATS). The most feared complication after hemothorax is the presence of retained blood and the risk of infection that follows. Most authorities support the early use of VATS to resolve retained hemothoraces with the hopes of avoiding more invasive procedures aimed at the treatment of fibrothorax and empyema.