IU Indianapolis ScholarWorks :: Browsing by Subject "trauma"

Browsing by Subject "trauma"

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Damage Control Thoracotomy: A Systematic Review of Techniques and Outcomes
(Elsevier, 2021-05) Douglas, Anthony, II; Puzio, Thaddeuss; Murphy, Patrick; Menard, Laura; Meagher, Ashley D.; Surgery, School of Medicine
Background : Damage control surgery is the practice of delaying definitive management of traumatic injuries by controlling hemorrhage in the operating room and restoring normal physiology in the intensive care unit prior to definitive therapy. Presently, damage control or “abbreviated” laparotomy is used extensively for abdominal trauma in an unstable patient. The application of a damage control approach in thoracic trauma is less established and there is a paucity of literature supporting or refuting this practice. We aimed to systematically review the current data on damage control thoracotomy (DCT), to identify gaps in the literature and techniques in temporary closure. Methods : An electronic literature search of Pubmed, MEDLINE, and the Cochrane Database of Collected Reviews from 1972-2018 was performed using the keywords “thoracic,” “damage control,” and “thoracotomy.” Studies were included if they reported the use of DCT following thoracic trauma and included survival as an outcome. Results : Of 723 studies, seven met inclusion criteria for a total of a 130 DCT operations. Gauze packing with temporary closure of the skin with suture was the most frequently reported form of closure. The overall survival rate for the seven studies was 67%. Survival rates ranged from 42-77%. Average injury severity score was 30, and 64% of injuries were penetrating in nature. The most common complications included infections (57%; pneumonia, empyema, wound infection, bacteremia), respiratory failure (21%), ARDS (8%), and renal failure (18%). Conclusion : DCT may be associated with improved survival in the critically injured patient population. Delaying definitive operation by temporarily closing the thorax in order to allow time to restore normal physiology may be considered as a strategy in the unstable thoracic trauma patient population. The impact an open chest has on respiratory physiology remains inconclusive as well as best mechanisms of temporary closure. Multi-center studies are required to elucidate these important questions.
Development of a trauma-informed care framework for a local student outreach clinic: A doctoral capstone experience and project
(2024-05-24) Ballinger, Valerie; DeRolf, Annie; Department of Occupational Therapy, School of Health and Human Sciences; Hess, Pamela
Majority of the world’s population has experienced a traumatic event in their lifetime. Trauma-informed care (TIC) framework was created for people to recognize trauma and the impact it has on the way the show up in the world. TIC framework uses safe principles and practices for those that have experienced a traumatic event in order not to retraumatized them. The doctoral capstone site is a student-run clinic which most volunteers have not had experience with TIC framework. TIC framework is an evidence-based approach that helps rapport and safety for everyone. The purpose of this capstone project was to educate student volunteers on TIC framework to bridge the gap of using a TIC approach at the clinic and prevent retraumatization. For the education materials, ten modules were created and implemented in the clinic. Data was collected and analyzed before and after the educational materials. Participants showed increased understanding and confidence with using TIC approach. Participants expressed interest in wanting to implement TIC framework into their practice after the project. These project results indicated a further investigation into becoming a trauma-informed organization.
Development of Resources to Improve Sensory Regulation in the Classroom
(2024-04-26) Rizzo, Hannah; Hess, Pamela; Hess, Pamela; Department of Occupational Therapy, School of Health and Human Sciences; N/A, N/A
The purpose of this doctoral capstone project was to develop and provide sensory based resources to teachers, occupational therapists, and families throughout a large Florida school district to improve student regulation. Through the needs assessment, it was discovered that the school system had a goal to decrease maladaptive behavior and suspensions. To support this goal, four resources were created; a teacher’s handbook to sensory processing and regulation, a sensory pathway that students can utilize for regulation, newsletters for families on sensory processing and activities to support development, and a list of equipment to purchase to support the creation of a sensory library. Trainings were provided to teachers on how to utilize the handbook created.
Diagnostic Yield and Clinical Utility of Abdominopelvic CT Following Emergent Laparotomy for Trauma
(RSNA, 2016-09) Haste, Adam K.; Brewer, Brian L.; Steenburg, Scott D.; Department of Surgery, IU School of Medicine
Purpose To determine the incidence of unexpected injuries that are diagnosed with computed tomography (CT) after emergent exploratory laparotomy for trauma and whether identification of such injuries results in additional surgery or angiography. Materials and Methods This HIPAA-compliant retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. The trauma databases of two urban level 1 trauma centers were queried over a period of more than 5 years for patients who underwent abdominopelvic CT within 48 hours of emergent exploratory laparotomy for trauma. Comparisons were made between CT findings and those described in the surgical notes. Descriptive statistics were generated, and 95% confidence intervals (CIs) were determined by using an exact method based on a binomial distribution. Results The study cohort consisted of 90 patients, including both blunt and penetrating trauma victims with a median injury severity score of 17.5 (interquartile range, 9.25–34). Seventy-three percent (66 of 90) of patients sustained penetrating trauma, 82% (74 of 90) of whom were male. A total of 19 patients (21.1%; 95% CI: 13.2, 31.0) had additional injuries within the surgical field that were not identified during laparotomy. There were 17 unidentified solid organ injuries, and eight patients had active bleeding within the surgical field. Eight patients (8.9%; 95% CI: 3.9, 16.8) had unexpected injuries at CT that were substantial enough to warrant additional surgery or angiography. In addition, previously undiagnosed fractures were found in 45 patients (50%; 95% CI: 39.3, 60.7). Conclusion Performing CT after emergent exploratory laparotomy for trauma is useful in identifying unexpected injuries and confirming suspected injuries that were not fully explored at initial surgery.
Doctoral Capstone: A Process Evaluation of the Implementation of Trust-Based Relational Interventions within Indian Creek Schools
(2023-05-02) McGillem, Cassandra L.; Petrenchik, Terry; Department of Occupational Therapy, School of Health and Human Sciences; Long, Eric
This doctoral capstone project focuses on conducting a process evaluation of the implementation of Trust-Based Relational Interventions (TBRI) within Indian Creek Schools. TBRI is a trauma-informed approach that focuses on connecting with, empowering, and correcting children to obtain positive behavior changes (Purvis et al., 2013). With increasing literature surrounding trauma and its negative impact on the occupation of education, occupational therapists have the opportunity to advocate for trauma-informed practices within the school setting. This doctoral capstone began with a needs assessment and literature review which allowed the capstone student to gather pertinent background information regarding TBRI and the site. The capstone student attended a TBRI caregiver training, created and distributed surveys to the teachers at Indian Creek Schools, and conducted interviews with the teachers. 15.6% (n=21) of the teachers (n=134) completed a survey and 6.7% (n=9) of the teachers participated in an interview with the capstone student. While this was a low response rate, the capstone student was able to share with the site the data regarding the evaluation of the implementation process. The process evaluation revealed that the teachers felt either unequipped to apply TBRI or did not see the value in utilizing TBRI. Both of these factors lead to the inconsistent implementation of TBRI within Indian Creek Schools. This low implementation fidelity has led to many teachers abandoning the program prior to meeting desired outcomes. Understanding the current process of implementation is a key baseline component to ensure the future success of TBRI in meeting the needs of the Indian Creek Schools.
Effects of Intergenerational Trauma on Motherhood Post Incarceration: Implications for Occupational Therapy Services During the Reentry Process
(2023-05) Fischer, Keeley S.; Annie, DeRolf; Department of Occupational Therapy, School of Health and Human Sciences; Vest, Breea
Community reentry is the process of reintegrating individuals who have been incarcerated back into society. It is a challenging process that requires a multitude of resources to be successful. Unfortunately, individuals who have been released from jail or prison lack the necessary resources for successful reentry. Individuals with justice system involvement commonly face external barriers such as discrimination in housing, employment, and education. Common internal barriers include negative or limiting personal beliefs, roles, and habits. For mothers who have been incarcerated, the community reentry process can be particularly difficult, facing unique challenges related to their role as caregivers. Judgment and stigma from society, along with mothers often bearing the primary responsibility for the care and well-being of their children, often results in increased difficulty securing stable housing, employment, and access to resources required for the care and provide for their children.
Girl Power: A Girls Empowerment and Social-Emotional Skills Program at the Boys and Girls Club
(2024) Kelly, Chandler; Wasmuth, Sally; Department of Occupational Therapy, School of Health and Human Sciences; Harris, LeeAnn
Due to the circumstances of the home environment or living conditions, many of the students attending the Boys and Girls Club have experienced trauma and thus have high adverse childhood experience (ACE) scores. According to research, emotional regulation and coping skills can contribute to minimizing racial trauma and preventing adverse childhood experiences (ACEs). Additionally, the program director of the Boys and Girls Club identified that many of the members have difficulty with emotional regulation, coping skills, and self-esteem. The purpose of this capstone project was to address and meet these needs by developing and implementing a girls empowerment, social-emotional skills program. Intervention activities focused on emotional regulation, coping skills, interoception, and self-esteem. The girls demonstrated satisfaction with their participation in the program by stating that they enjoyed the activities, reporting something they learned, and recommending the program to other girls. A digital and physical program handbook was created to improve sustainability and increase likelihood of continuation of program implementation after the conclusion of the capstone.
Infectious Complications in Obese Patients Following Trauma
(Elsevier, 2016-04) Bell, Teresa Maria; Bayt, Demetria R.; Siedlecki, Charles B.; Stokes, Samantha M.; Yoder, Joseph; Jenkins, Peter; Fecher, Alison M.; Department of Surgery, IU School of Medicine
Background Obesity is a public health concern in the United States due to its increasing prevalence, especially in younger age groups. Trauma is the most common cause of death for people under aged 40 y. The purpose of this study is to determine the association between obesity and specific infectious complications after traumatic injury. Materials and methods A retrospective analysis was conducted using data from the 2012 National Trauma Data Bank. The National Trauma Data Bank defined obesity as having a body mass index of 30 or greater. Descriptive statistics were calculated and stratified by obesity status. A hierarchical regression model was used to determine the odds of experiencing an infectious complication in patients with obesity while controlling for age, gender, diabetes, number of comorbidities, injury severity, injury mechanism, head injury, and surgical procedure. Results Patients with a body mass index of 30 or greater compared with nonobese patients had increased odds of having an infectious complication (Odds Ratio, 1.59; 1.49-1.69). In addition to obesity, injury severity score greater than 29, age 40 y or older, diabetes, comorbid conditions, and having a surgical procedure were also predictive of an infectious complication. Conclusions Our results indicate that trauma patients with obesity are nearly 60% more likely to develop an infectious complication in the hospital. Infection prevention and control measures should be implemented soon after hospital arrival for patients with obesity, particularly those with operative trauma.
Methodology, selection, and integration of fracture healing assessments in mice
(Wiley, 2021-11) Knox, Adam M.; McGuire, Anthony C.; Natoli, Roman M.; Kacena, Melissa A.; Collier, Christopher D.; Orthopaedic Surgery, School of Medicine
Long bone fractures are one of the most common and costly medical conditions encountered after trauma. Characterization of the biology of fracture healing and development of potential medical interventions generally involves animal models of fracture healing using varying genetic or treatment groups, then analyzing relative repair success via the synthesis of diverse assessment methodologies. Murine models are some of the most widely used given their low cost, wide variety of genetic variants, and rapid breeding and maturation. This review addresses key concerns regarding fracture repair investigations in mice and may serve as a guide in conducting and interpreting such studies. Specifically, this review details the procedures, highlights relevant parameters, and discusses special considerations for the selection and integration of the major modalities used for quantifying fracture repair in such studies, including X-ray, microcomputed tomography, histomorphometric, biomechanical, gene expression and biomarker analyses.
Nasal Bone Fractures and the Use of Radiographic Imaging: An Otolaryngologist Perspective
(Elsevier, 2019-11) Westfall, Edward; Nelson, Benton; Vernon, Dominic; Saltagi, Mohamad Z.; Mantravadi, Avinash V.; Schmalbach, Cecelia; Ting, Jonathan Y; Shipchandler, Taha Z.; Otolaryngology -- Head and Neck Surgery, School of Medicine
Objective To determine radiologic preferences of practicing otolaryngologists regarding isolated nasal bone fractures. Study design An 8-question survey on isolated nasal bone fractures was designed. Setting Surveys were sent to all otolaryngology residency program directors for distribution among residents and faculty. Additional surveys were distributed to private practice otolaryngology groups. Results 140 physicians responded to the survey. 57% of the respondents were practicing otolaryngologists (75% with 10+ years of experience), while 43% of respondents were residents-in-training. 56% of respondents treated 1–5 nasal bone fractures per month. 80% of all respondents reported imaging being performed prior to consultation. If imaging was obtained before consultation, plain films and computed tomography (CT) maxillofacial/sinus scans were the most frequent modalities. 33% of residents and 70% of practicing otolaryngologists report imaging as ‘rarely’ or ‘never’ helpful in guiding management. 42% of residents and 20% of practicing otolaryngologists report asking for imaging when it wasn't already obtained. Decreased use of radiography was associated with greater years in practice and higher frequency of fractures treated. Conclusions and relevance Otolaryngologists seldom request imaging to evaluate and treat isolated nasal bone fractures. When ordered, imaging is utilized more often among residents-in-training and non-otolaryngology consulting physicians. This study highlights an opportunity to educate primary care and emergency room providers as well as otolaryngology residents on the value of comprehensive physical exam over radiographic imaging in the work-up of isolated nasal fractures. In addition, widespread adoption of a “no x-ray policy” in this setting may result in better resource utilization.

Browsing by Subject "trauma"

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