Acute child and mother psychophysiological responses and subsequent PTSD symptoms following a child's traumatic event.
MENTAL depression; POST-traumatic stress disorder; RESEARCH; STATISTICAL sampling; HYDROCORTISONE; CHILDREN; MOTHERS; TRAUMA centers; URINE
This study examined the relationship between acute cortisol responses to trauma and subsequent PTSD symptoms (PTSS) in children and their biological mothers. Urinary cortisol levels were assessed in 54 children aged 8–18 upon admission to a level-1 trauma center. Six weeks posttrauma, 15-hour urine samples were collected from children and their mothers. Depression and PTSS were assessed at 6 weeks (N = 44) and 7 months (N = 38) posttrauma. Higher child in-hospital cortisol significantly predicted 6-week child PTSS. This was true only for boys at 7 months. In mothers, lower 6-week cortisol levels significantly predicted 7-month PTSS. Results extend findings of differing directions of acute hormonal predictors of PTSS in adults versus children to a sample of genetically related individuals. [ABSTRACT FROM AUTHOR]
Ostrowski Sarah A; Christopher Norman C; van Dulmen Manfred HM; Delahanty Douglas L
Journal of Traumatic Stress
2007
2007-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/jts.20286" target="_blank" rel="noreferrer noopener">10.1002/jts.20286</a>
Improving a mature palliative care program at a Level I trauma center.
Advance Directives; Confidence Intervals; Data Analysis Software; Depression; Descriptive Statistics; Documentation; Electronic Health Records; Fisher's Exact Test; Frailty Syndrome; Hospital Programs; Human; Palliative Care; Pearson's Correlation Coefficient; Quality Improvement; Questionnaires; Simulations; Trauma Centers
Background: Similar to the significant rise in the geriatric population in the United States, trauma centers have seen an increase in geriatric trauma patients. These patients present with additional challenges such as a higher likelihood of undertriage, mortality, and frailty. In addition, the varying presence of advanced directive documentation increases the importance of early palliative care consultations for geriatric trauma patients. Objective: In 2018, a Level I trauma center in the Midwest reviewed the American College of Surgeons Trauma Quality Improvement Program's Palliative Care Best Practice Guideline to identify opportunities for improvement to strengthen the collaboration between the palliative care consult service and trauma program. Methods: The guideline drove improvements, which included documentation changes (i.e., expansion of palliative care consultation triggers, frailty assessment, advanced directives questions, depression screening, and addition of palliative care consultation section on the performance improvement program form) and training (1-hr lecture on palliative care and 5-hr palliative care simulation training) opportunities. Results: A 3-month manual chart review (March 2019 through May 2019) revealed that by May 2019, 87.2% of admitted geriatric trauma patients received frailty assessments, which surpassed the benchmark (>85%). In addition, advanced care planning questions (i.e., health care power of attorney, do not resuscitate order, or living will) exceeded the benchmarks set forth by the guideline (>90%), with all of the questions being asked and documented in 95.7% of those same patient charts by May 2019. Conclusion: This quality improvement project has applicability for trauma centers that treat geriatric trauma patients; using the guidelines can drive changes to meet individual institution needs.
Moran ME; Soltis M; Politis T; Gothard MD; George RL
Journal Of Trauma Nursing
2021
2021-04-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/JTN.0000000000000569" target="_blank" rel="noreferrer noopener">10.1097/JTN.0000000000000569</a>
A Critical Pathway for Mass Casualty Incident Preparedness.
Rates of mass casualty incidents (MCIs) have been on the rise in the United States, highlighting the need for health care systems to have an emergency response plan. Trauma centers are fundamental during MCIs and serve a crucial leadership role in preparedness for them.
A quasi-experimental time-series design was utilized to determine MCI simulation effects on staff performance using an emergency department checklist to measure emergency department throughput time. A multidisciplinary MCI design team developed a checklist for the emergency department, which identified tasks required to complete it. The 16-item checklist, Critical Pathway Management methodology, was used to identify the critical pathway for patient throughput during a surge. Two in situ MCI simulation drills were conducted in the emergency department (October and December 2019), and Critical Pathway Management identified the primary patient throughput rate limiters as notification and inpatient nursing staff presentation.
Moran ME; Blecker N; Gothard MD; George RL
Journal Of Trauma Nursing
2021
2021-07-01
Journal Article
<span class="identifier doi"><a class="id-link" target="_blank" href="https://doi.org/10.1097/jtn.0000000000000597" rel="noreferrer noopener">10.1097/JTN.0000000000000597</a></span>