Articles: trauma.
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Adverse childhood experiences (ACEs) are often reported by youths with chronic pain, and both ACEs and chronic pain disrupt how information is processed. However, it is unknown whether changes to shared neural networks underlie the relationship between ACEs and the development of pain symptoms. This study explored the relationships between ACEs, brain efficiency, and pain symptomology in youth. ⋯ This article explores the relationship between ACEs, pain symptomology, and brain efficiency in youth. ACEs may affect how the brain processes information, including pain. Youths with lower brain efficiencies that were exposed to more ACEs have pain symptomology comparable to youths with chronic pain. Understanding this relationship is important for the earlier identification of pain symptoms, particularly in vulnerable populations such as youths exposed to trauma, and is critical for preventing the chronification of pain.
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An abnormal shock index (SI) is associated with greater injury severity among children with trauma. We sought to empirically-derive age-adjusted SI cutpoints associated with major trauma in children, and to compare the accuracy of these cutpoints to existing criteria for pediatric SI. ⋯ Age-adjusted SI cutpoints demonstrated a mild gain in sensitivity compared to existing measures. However, our findings suggest that the SI alone has a limited role in the identification of major trauma in children.
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Journal of women's health · Jan 2025
Electronic Health Record Concordance with Survey-Reported Military Sexual Trauma Among Younger Veterans: Associations with Health Care Utilization and Mental Health Diagnoses.
Introduction: Military sexual trauma (MST) is more common among post-9/11 Veterans and women versus older Veterans and men. Despite mandatory screening, the concordance of electronic health record (EHR) documentation and survey-reported MST, and associations with health care utilization and mental health diagnoses, are unknown for this younger group. Materials and Methods: Veterans' Health Administration (VHA) EHR (2001-2021) were merged with data from the observational, nationwide WomenVeterans Cohort Study (collected 2016-2020, n = 1058; 51% women). ⋯ There was no group difference in women's likelihood of anxiety. Conclusions: EHR MST documentation is discordant for many post-9/11 Veterans-both for men and women. Improving MST screening and better supporting MST disclosure are each critical to provide appropriate and timely care for younger Veterans, particularly women.
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Paediatric anaesthesia · Jan 2025
Trauma-induced coagulopathy across age pediatric groups: A retrospective cohort study evaluating testing and frequency.
Trauma-induced coagulopathy (TIC) is associated with negative outcomes. Pediatric TIC has been described most often in older children. Children undergo normal developmental hemostasis, but it is unknown how this process impacts the risk of TIC across childhood. ⋯ Significant sampling bias exists in clinical data collection among injured children and adolescents. Contrary to previous reports and using age-specific TIC criteria, younger children are not at lower risk of TIC than older children when controlling for injury severity.
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The occurrence and sequelae of acute myocardial infarction (AMI) in major trauma patients is underexplored across both trauma and cardiology specialties. Coronary reperfusion greatly reduces the risk of significant morbidity and mortality in AMI. However, in patients presenting with significant injuries, concurrent AMI presents a competing management priority given the increase in risk of bleeding with standard anticoagulation and antiplatelet therapy, which may be contraindicated. This study aimed to evaluate the epidemiology and clinical outcomes associated with AMI in a contemporary major trauma cohort. ⋯ AMI in the setting of major trauma occurs in an older, more comorbid, and vulnerable group of patients. AMI is associated with an increased risk of in-hospital mortality and prolonged hospital stay in the setting of major trauma, underscoring the importance of identifying and treating major trauma associated AMI in a timely and effective manner.