Factors Related Pain Catastrophizing in Hospitalized Patients with Trauma

Objective: This study aimed to explore the factors related to pain catastrophizing (PC) in hospitalized patients with trauma within 72 hours of injury. Materials and Methods: The study was a cross-sectional correlation study. The sample was 109 patients who were admitted to ICU Trauma or General Trauma Unit within 72 hours after injury and were aged 18 years and over. They were diagnosed with at least one or multiple organs of injury with a Glasgow Coma Scale (GCS) between 13 and 15. Pearson’s product-moment correlation coefficient, spearman rank correlation, point-biserial correlation, and linear multiple regression were used to analyze the data. Results: The results showed that more than half of the sample was male (73.0%) with the age range from 18 to 91 years. During admission, the subjects complained about pain at moderate to severe levels (68.5%). The prevalence of PC was 11.9%. A few participants (2.8%) experienced anxiety. Also, more than half of them (63.3%) had ADLs in independent to absolutely independent levels. Almost 50.5% of the participants experienced poor sleep quality. Lastly, 50.5% of them were in frailty and pre-frailty conditions. There was a positive relationship between PC and anxiety (r = .439, p < .01). Finally, anxiety could explain the variance of PC by 19.3% (F1,107 = 25.571, P < .001). Conclusion: Based on the study findings, the predictor of PC was anxiety. Thus, healthcare providers should assess this factor, in order to provide interventions to reduce high levels of anxiety leading to the prevention of PC occurrences in hospitalized trauma within 72 hours after injury

Clinical Efficacy Test of Polyester Dressing Containing Herbal Extracts and Silver Sulfadiazine Cream Compared with Silver Sulfadiazine Cream in Healing Burn Wounds: A Prospective Randomized Controlled Trial

The standard burn wound treatment is the application of silver zinc sulfadiazine cream, covered with sterilized gauze dressing. This method has been used for decades because of its reasonable costs and applicability for larger wound sizes. However, gauze with a large pore size may stick to the wound bed and cause wound trauma, leading to delayed healing. The patient may also experience additional pain during changing the dressing. The non-adherent property of a hydrocolloid dressing coated with herbal extract (SIHERB) can promote wound healing as well as reduce pain. This study compared the two methods of burn wound treatment in the same patients, who were split into a “treatment group”, who were applied both silver sulfadiazine cream and hydrocolloid dressing, and “control group”, who were applied only silver sulfadiazine cream. The studied outcomes were the number of days for wound closure, the percentage epithelialization, and the pain score (evaluated every three days until epithelialization was completed). In total, 24 patients at the Burn Clinic, Siriraj Hospital were enrolled on this study. The starting wound areas were ranged from 210–220 cm2. The treatment group exhibited significant results regarding faster wound healing, referring to the number of days taken for wound closure (18 days in the control group vs. 15 days in the experimental group) and the percentage epithelialization compared to the control group. The average pain score in the experimental group was also lower on days 9, 12, and 15 after treatment (p < 0.05). No adverse effects were observed during the study. In conclusion, the combination of hydrocolloid dressing and silver sulfadiazine cream could reduce the wound shearing force and wound bed injury, accelerating the rate of wound closure and decreasing the pain during changing the dressing. This technique could improve upon the standard burn wound treatment

A Prospective Randomized Controlled Trial Comparing Infection Rates of the Daily Dressing and Scheduled Dressing of Sutured Traumatic Wounds

Objective: To evaluate outcome differences between DD and SD in 1) wound infection rates, 2) patients’ satisfaction according to the wound care and cost of treatment. Methods: A single-center, prospective randomized controlled trial of 350 traumatic-wound patients was conducted. Only adult traumatic wounds without a fracture, tendon injury and neurovascular injury were included. The patients were randomized into two groups: daily dressing (DD) and scheduled dressing (SD) groups. DD group patients received daily wound dressing changes, while those in SD group typically had dressing changed on days 3, 7 and one other scheduled day. Analyzed data included patients’ demographics, clinical parameters, patient’s satisfaction according to wound treatment and cost. Results: Total wound infection rate was 1.2%. Although the incidence of wound infection in the SD group was lower than that of the DD group (0% vs. 2.4%), statistically it was not significant (p=0.06). Patients’ satisfaction level was also not significantly different between the two groups. Conclusion: The study showed clinical non-inferiority of SD compared to DD while offering saving benefits both in time and cost. Therefore, SD can be substituted for DD for traumatic wound care after primary repair

Clinical Efficacy of Andrographis paniculata Extracted Scrub Compared With 4% Chlorhexidine Scrub in Burn Wounds: A Prospective Randomized Controlled Trial

Objective: The primary objective of this study is to compare the healing rate between AP soap and 4% Chlorhexidine solution in superficial second-degree burn wounds. The secondary objectives include the analgesic effect and moisturization of these two products. Materials and Methods: Data was collected between 2019 and 2021. Patients aged 18 years and above, with superficial second-degree burns including at least 20% of TBSA, and admitted to the Burn Unit within 24 hours of injury were included. They were randomly assigned to two groups: Andrographis paniculata with Perilla oil liquid soap group (AP group) and 4% Chlorhexidine group (control group). The measurements included percentage of epithelialization, pain score during wound cleansing, itching score after wound cleansing, and dry skin specified symptoms. All patients received standard care for burn wound treatment. Results:  A total enrollment was 23 patients in this study (12 in the AP group and 11 in the control group). The median age was 38.5 years. There were no statistically significant differences in age, %TBSA, and initial wound size between both groups (p > 0.05). Although the healing time was similar in both groups, (18.5 vs. 20.1, p=0.347), the AP group had a significantly lower pain score than the control group (4.7 vs. 5.4, p=0.020). Moreover, the AP group demonstrated significant improvements in itching score and SRRC score at 14 days compared to the control group (5.1 vs. 6.0, p 0.039 and 1.08 vs. 1.55, p 0.020, respectively). There were no adverse effects during this study.  Conclusion: Patients treated with Andrographis paniculata with Perilla oil liquid soap experienced less pain and better moisturization compared to those treated with the standard 4% chlorhexidine solution, while achieving a comparable healing rate. A future large-scale prospective trial is recommended

Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis

Abstract Background Damage control strategies play an important role in trauma patient management. One such strategy, hypotensive resuscitation, is being increasingly employed. Although several randomized controlled trials have reported its benefits, the mortality benefit of hypotensive resuscitation has not yet been systematically reviewed. Objectives To conduct a meta-analysis of the efficacy of hypotensive resuscitation in traumatic hemorrhagic shock patients relative to mortality as the primary outcome, with acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and multiple organ dysfunction as the secondary outcomes. Methods PubMed, Medline-Ovid, Scopus, Science Direct, EMBASE, and CNKI database searches were conducted. An additional search of relevant primary literature and review articles was also performed. Randomized controlled trials and cohort studies reporting the mortality rate associated with hypotensive resuscitation or limited fluid resuscitation were selected. The random-effects model was used to estimate mortality and onset of other complications. Results Of 2114 studies, 30 were selected for this meta-analysis. A statistically significant decrease in mortality was observed in the hypotensive resuscitation group (risk ratio [RR]: 0.50; 95% confidence interval [CI]: 0.40–0.61). Heterogeneity was observed in the included literature (I2: 27%; degrees of freedom: 23; p = 0.11). Less usage of packed red cell transfusions and fluid resuscitations was also demonstrated. No significant difference between groups was observed for AKI; however, a protective effect was observed relative to both multiple organ dysfunction and ARDS. Conclusions This meta-analysis revealed significant benefits of hypotensive resuscitation relative to mortality in traumatic hemorrhagic shock patients. It not only reduced the need for blood transfusions and the incidences of ARDS and multiple organ dysfunction, but it caused a non-significant AKI incidence

Effect of noninvasive respiratory support on interstitial lung disease with acute respiratory failure: A systematic review and meta-analysis

# Background Primary studies have demonstrated the effectiveness of noninvasive respiratory supports, including noninvasive positive pressure ventilation (NIPPV) and high flow nasal cannula (HFNC), for improving oxygenation and ventilation in patients with interstitial lung diseases (ILDs) and acute respiratory failure (ARF). These studies have not been synthesized and are not included in current practice guidelines. This systematic review with meta-analysis synthesizes studies that compared the effectiveness of NIPPV, HFNC and conventional oxygen therapy (COT) for improving oxygenation and ventilation in ILD patients with ARF. # Methods MEDLINE, EMBASE and the Cochrane Library searches were conducted from inception to August 2023. An additional search of relevant primary literature and review articles was also performed. A random effects model was used to estimate the PF ratio (ratio of arterial oxygen partial pressure to fractional inspired oxygen), PaCO~2~ (partial pressure of carbon dioxide), mortality, intubation rate and hospital length of stay. # Results Ten studies were included in the systematic review and meta-analysis. Noninvasive respiratory supports demonstrated a significant improvement in PF ratio compared to conventional oxygen therapy (COT); the mean difference was 55.92 (95% CI $$18.85-92.99$$; *p*=0.003). Compared to HFNC, there was a significant increase in PF ratio in NIPPV (mean difference 0.45; 95% CI $$0.12--0.79$$; *p*=0.008). There were no mortality and intubation rate benefits when comparing NIPPV and HFNC; the mean difference was 1.1; 95% CI $$0.83-1.44$$; *p*=0.51 and 1.86; 95% CI $$0.42-8.33$$; *p*=0.42, respectively. In addition, there was a significant decrease in hospital length of stay in HFNC compared to NIPPV (mean difference 9.27; 95% Cl $$1.45 -- 17.1$$; *p*=0.02). # Conclusions Noninvasive respiratory supports might be an alternative modality in ILDs with ARF. NIPPV demonstrated a potential to improve the PF ratio compared to HFNC. There was no evidence to support the benefit of NIPPV or HFNC in terms of mortality and intubation rate

COVID-19 in trauma: a propensity-matched analysis of COVID and non-COVID trauma patients.

PurposeThere is mounting evidence that surgical patients with COVID-19 have higher morbidity and mortality than patients without COVID-19. Infection is prevalent amongst the trauma population, but any effect of COVID-19 on trauma patients is unknown. We aimed to evaluate the effect of COVID-19 on a trauma population, hypothesizing increased mortality and pulmonary complications for COVID-19-positive (COVID) trauma patients compared to propensity-matched COVID-19-negative (non-COVID) patients.MethodsA retrospective analysis of trauma patients presenting to 11 Level-I and II trauma centers in California between 1/1/2019-6/30/2019 and 1/1/2020-6/30/2020 was performed. A 1:2 propensity score model was used to match COVID to non-COVID trauma patients using age, blunt/penetrating mechanism, injury severity score, Glasgow Coma Scale score, systolic blood pressure, respiratory rate, and heart rate. Outcomes were compared between the two groups.ResultsA total of 20,448 trauma patients were identified during the study period. 53 COVID trauma patients were matched with 106 non-COVID trauma patients. COVID patients had higher rates of mortality (9.4% vs 1.9%, p = 0.029) and pneumonia (7.5% vs. 0.0%, p = 0.011), as well as a longer mean length of stay (LOS) (7.47 vs 3.28&nbsp;days, p &lt; 0.001) and intensive care unit LOS (1.40 vs 0.80&nbsp;days, p = 0.008), compared to non-COVID patients.ConclusionThis multicenter retrospective study found increased rates of mortality and pneumonia, as well as a longer LOS, for COVID trauma patients compared to a propensity-matched cohort of non-COVID patients. Further studies are warranted to validate these findings and to elucidate the underlying pathways responsible for higher mortality in COVID trauma patients

Effects of the COVID-19 pandemic on pediatric trauma in Southern California.

PurposeThe COVID-19 pandemic resulted in increased penetrating trauma and decreased length of stay (LOS) amongst the adult trauma population, findings important for resource allocation. Studies regarding the pediatric trauma population are sparse and mostly single-center. This multicenter study examined pediatric trauma patients, hypothesizing increased penetrating trauma and decreased LOS after the 3/19/2020 stay-at-home (SAH) orders.MethodsA multicenter retrospective analysis of trauma patients ≤ 17&nbsp;years old presenting to 11 centers in California was performed. Demographic data, injury characteristics, and outcomes were collected. Patients were divided into three groups based on injury date: 3/19/2019-6/30/2019 (CONTROL), 1/1/2020-3/18/2020 (PRE), 3/19/2020-6/30/2020 (POST). POST was compared to PRE and CONTROL in separate analyses.Results1677 patients were identified across all time periods (CONTROL: 631, PRE: 479, POST: 567). POST penetrating trauma rates were not significantly different compared to both PRE (11.3 vs. 9.0%, p = 0.219) and CONTROL (11.3 vs. 8.2%, p = 0.075), respectively. POST had a shorter mean LOS compared to PRE (2.4 vs. 3.3&nbsp;days, p = 0.002) and CONTROL (2.4 vs. 3.4&nbsp;days, p = 0.002). POST was also not significantly different than either group regarding intensive care unit (ICU) LOS, ventilator days, and mortality (all p &gt; 0.05).ConclusionsThis multicenter retrospective study demonstrated no difference in penetrating trauma rates among pediatric patients after SAH orders but did identify a shorter LOS

The coronavirus disease 2019 (COVID-19) stay-at-home order’s unequal effects on trauma volume by insurance status in Southern California

BackgroundThe rapid spread of coronavirus disease 2019 in the United States led to a variety of mandates intended to decrease population movement and "flatten the curve." However, there is evidence some are not able to stay-at-home due to certain disadvantages, thus remaining exposed to both coronavirus disease 2019 and trauma. We therefore sought to identify any unequal effects of the California stay-at-home orders between races and insurance statuses in a multicenter study utilizing trauma volume data.MethodsA posthoc multicenter retrospective analysis of trauma patients presenting to 11 centers in Southern California between the dates of January 1, 2020, and June 30, 2020, and January 1, 2019, and June 30, 2019, was performed. The number of trauma patients of each race/insurance status was tabulated per day. We then calculated the changes in trauma volume related to stay-at-home orders for each race/insurance status and compared the magnitude of these changes using statistical resampling.ResultsCompared to baseline, there was a 40.1% drop in total trauma volume, which occurred 20 days after stay-at-home orders. During stay-at-home orders, the average daily trauma volume of patients with Medicaid increased by 13.7 ± 5.3%, whereas the volume of those with Medicare, private insurance, and no insurance decreased. The average daily trauma volume decreased for White, Black, Asian, and Latino patients with the volume of Black and Latino patients dropping to a similar degree compared to White patients.ConclusionThis retrospective multicenter study demonstrated that patients with Medicaid had a paradoxical increase in trauma volume during stay-at-home orders, suggesting that the most impoverished groups remain disproportionately exposed to trauma during a pandemic, further exacerbating existing health disparities