Abdominal Injury

This research aims to evaluate interventions to support family members who act as surrogate decision makers for critically ill patients in Intensive Care Units (ICUs). These surrogates often face intense grief and stress that can affect their mental health and the quality of decisions made for their loved ones near end-of-life. The study focuses on reducing symptoms of prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD), and related emotional challenges through a psychological intervention called EMPOWER. The study compares two approaches: the EMPOWER intervention, which is a brief, cognitive-behavioral and acceptance-based treatment delivered by trained mental health professionals, and a Supportive Conversation (SC) that provides empathetic support without specific skill-building. EMPOWER includes six 15-minute modules and two booster phone sessions, totaling about 90 minutes plus follow-ups, while the Supportive Conversation matches this time with supportive interaction and follow-up calls. Participants are assessed up to four times before and after the intervention within three months. Participants, who are surrogate decision makers of ICU patients near end-of-life, will complete assessments on grief, PTSD, depression, regret, anxiety, and distress before the intervention, immediately after, and at 3 and 12 months follow-up. The study also includes interviews with some participants to better understand the intervention's effects and contextual factors during the COVID-19 pandemic. The primary outcomes focus on changes in grief and PTSD symptoms over twelve months, with safety and mental health monitored throughout the study period.

Trauma is a leading cause of death in children in the US, with abdominal trauma accounting for 30% of pediatric traumatic deaths, second only to brain injury. This research evaluates the use of the Focused Assessment with Sonography for Trauma (FAST) examination, a bedside abdominal ultrasound, to determine if it can safely reduce abdominal CT scans in hemodynamically stable children with blunt abdominal trauma. The study aims to improve care quality and reduce morbidity and mortality by identifying appropriate evaluation strategies for injured children. The trial is a multicenter, randomized, controlled study involving 3,194 children under 18 years presenting within 24 hours of blunt abdominal trauma. Participants are assigned to either the FAST examination arm, where a bedside ultrasound is performed to detect blood in the abdomen, or to the standard care arm without FAST. The FAST exam is quick, radiation-free, and performed by emergency or trauma physicians. The study compares CT scan rates and tracks delayed or missed diagnoses of intra-abdominal injuries over up to 30 days. Throughout the emergency department stay and initial hospitalization (up to 24 hours), participants undergo assessments including FAST or standard evaluation, CT scan monitoring, and tracking of injuries for up to 30 days if hospitalized. Outcomes measured include CT scan frequency, missed injuries, emergency department length of stay, hospitalization rates, physician suspicion of injury, and surgery rates. The study also examines factors influencing CT use in low-risk patients after a negative FAST exam, aiming to optimize diagnostic care in pediatric trauma.

Researchers are evaluating the safety and effectiveness of abdominal wall transplantation to repair abdominal wall defects. This treatment may be done alone or along with another organ transplant. The study involves a small group of participants and aims to assess how well the transplanted abdominal wall restores function. Participants will receive either an isolated abdominal wall transplant or an abdominal wall transplant combined with another solid organ transplant. All participants will be given standard immunosuppression therapy similar to that used in other non-vascularized composite allograft organ transplants. The study will take place over 18 months at Duke University Medical Center. During the 18-month study period, participants will be closely monitored to see if the transplanted abdominal wall remains viable and functional. Researchers will evaluate the success of the transplant and monitor the participants’ health and response to treatment throughout this time. The primary measure is the number of subjects with a viable abdominal wall transplant at 18 months.

Researchers are evaluating the accuracy of the New Injury Severity Score (NISS) in predicting mortality and other outcomes in patients with blunt trauma admitted to the Emergency Department of Kadhimiya Educational Hospital in Iraq. This prospective observational study aims to understand how well NISS predicts death, the need for intensive care, and the length of hospital stay among trauma patients, addressing a research gap in resource-limited healthcare settings. Participants admitted with blunt trauma will be assessed using the NISS score within the first six hours of arrival to the emergency department to ensure accurate trauma evaluation. Their clinical progress, including mortality, need for intensive care, hospital stay duration, and surgical interventions, will be monitored throughout hospitalization, averaging six days. During the study, patients' anatomical injuries and physiological parameters will be documented to calculate the NISS. Researchers will track outcomes such as in-hospital mortality and length of hospitalization, with follow-ups at days 7 and 30 after discharge. This study will provide valuable information on the usefulness of NISS in managing blunt trauma in Iraq and contribute to improving trauma care protocols.

Researchers are collecting and analyzing data from patients with Acute Subdural Hematoma to better understand the effects of different surgical treatments. This observational study focuses on comparing standard surgical options such as burr hole trephination, craniotomy, decompressive craniectomy, and a newer technique called Middle Meningeal Artery embolization. The goal is to evaluate how these procedures impact survival outcomes in trauma patients. The study gathers information retrospectively from the Methodist Dallas Medical Center Trauma Registry. Data collected includes patient demographics, diagnosis codes, injury details, surgical procedures, complications, laboratory results, and outcomes such as discharge status and mortality. This comprehensive data collection allows researchers to observe real-world treatment effects without altering patient care. Participants are trauma patients aged 18 years or older who have an acute subdural hematoma diagnosed by brain CT or MRI within 72 hours of injury. Researchers will review medical records and imaging to collect relevant information. The primary measurement is the total number of study sites and subjects over five years. There is no active treatment or intervention; instead, the study monitors and analyzes existing clinical data to improve understanding of surgical options and patient outcomes.

This research aims to study how alcohol use, psychoactive drugs, or prior pain medication affect the clinical evaluation and surgical decisions for patients with penetrating abdominal trauma. It is conducted as a prospective observational study in two high-volume trauma centers in Cali, Colombia, including a public and a private university hospital. The study addresses concerns about whether intoxication or altered mental status might reduce the reliability of serial physical examinations, which are commonly used to decide if surgery is needed in these patients. Patients aged 15 years and older who have penetrating abdominal trauma and are hemodynamically stable will be evaluated using standard care protocols at these centers. This includes serial physical examinations and selective use of imaging tests like focused abdominal sonography or CT scans when necessary. The study does not add any extra procedures and classifies patients based on whether they consumed alcohol, used psychoactive substances, or received analgesics before evaluation. The main focus is the time from hospital admission to the decision for surgery, with other outcomes like trauma severity, surgery need, hospital stay length, complications, and mortality also being studied. Participants will be followed during their hospital stay, with data collected through electronic forms and verified for accuracy. Researchers will analyze the timing of surgical decisions and compare outcomes between patients with and without substance exposure. This study aims to provide evidence on the safety and reliability of serial physical examination in these trauma patients and may help improve trauma care protocols. The total observation period includes up to 28 days for surgical decision and related outcomes.

Researchers are gathering detailed information about patients who have experienced severe bleeding that required a massive transfusion, such as after serious injury, surgery, or childbirth. This observational study collects and analyzes data to better understand how often these events occur, what happens to patients, and how blood transfusions are used in these situations. The study is conducted by Monash University and includes data from multiple hospitals in Australia and New Zealand. The study uses electronic methods to collect existing clinical data from hospital databases, including transfusion records and patient demographics. This information is securely linked and analyzed to provide insights into transfusion practices and patient outcomes after critical bleeding events. The registry includes data from over 6,000 patients across 25 sites, covering various clinical settings such as trauma, surgery, obstetrics, and gastrointestinal bleeding. Participants in this study are adults who experienced critical bleeding and received at least five units of red blood cells within four hours. The study monitors outcomes such as mortality within 30 days after the bleeding event. Data linkage with national death indexes and other registries helps provide comprehensive outcome measurements. The study allows ongoing collection and analysis of data to improve transfusion policies and patient care practices over time.

Researchers are investigating blunt adrenal gland injury (BAGI), a rare condition occurring after blunt thoraco-abdominal trauma. This observational multicenter study focuses on adult patients who have undergone either non-operative or operative management. The study aims to clarify the conflicting reports about BAGI’s impact on trauma severity and patient outcomes, and to explore whether the injury's anatomical location or other physiological factors influence these outcomes. The study collects data from multiple institutions by reviewing medical records of patients with blunt thoraco-abdominal trauma, comparing those with BAGI to those without. Key information includes demographics, trauma mechanism, treatment details, trauma severity scores, ventilation needs, vasoactive support, clinical and laboratory parameters, mortality, and hospital stays. Data analysis will follow established observational study guidelines and use statistical matching to fairly compare the two patient groups. Participants will have their information gathered retrospectively from trauma registries, with personal data anonymized. The study measures injury severity scores, organ injury scales, survival rates, length of hospital and ICU stays over a 120-day period after trauma. This comprehensive evaluation helps understand the burden of BAGI among major trauma patients and aims to improve knowledge about this injury’s clinical implications.

Refugees and asylum seekers often experience traumatic events and ongoing stressors that increase their risk for mental health problems. However, accessing appropriate mental health care in host countries can be difficult due to barriers like long waitlists, stigma, and communication challenges. This research aims to expand the existing Problem Management Plus (PM+) intervention by adding booster sessions and homework reminders while evaluating its effectiveness and implementation in public health systems. Participants in the study will be randomly assigned to either receive the PM+ intervention or be part of a waitlist control group. The PM+ intervention includes five sessions of psychological support based on techniques such as problem solving, stress management, behavioral activation, and social support. Those in the intervention group will also receive three telephone booster sessions and handouts with homework reminders. The control group will receive the intervention 12 months after the initial assessment. During the study, participants will undergo assessments of psychological distress and other mental health symptoms at baseline, 3 months, 6 months, and 12 months. The study will measure changes in psychological distress, posttraumatic stress disorder symptoms, somatic symptoms, post-migration stressors, integration levels, suicidal ideation, self-efficacy, prolonged grief, anger, coping strategies, and other factors. The total participation period involves follow-up assessments up to 12 months after the baseline.

The CAlcium and VAsopressin following Injury Early Resuscitation (CAVALIER) Trial is a multi-center, double-blind, randomized study lasting four years. It focuses on patients at risk of hemorrhagic shock after traumatic injury, evaluating whether early administration of calcium and vasopressin can improve resuscitation outcomes. The trial aims to understand the safety and effectiveness of these treatments during the prehospital and early hospital phases of care. Participants may receive either 1 gram of calcium gluconate intravenously or intraosseously before arriving at the trauma bay, or a matching saline placebo. In the early hospital phase, patients may receive a vasopressin bolus followed by an infusion for eight hours, or a volume-matched saline placebo. These interventions are compared to standard care to assess their effects on hemorrhagic shock management. Throughout the study, participants will be monitored for mortality up to 30 days, blood transfusion needs, organ failure, infections, coagulation status, and time to hemostasis. Ionized calcium levels will be measured during early resuscitation. The trial also tracks intensive care unit and hospital-free days. Safety and treatment effects are assessed from enrollment through hospital stay and follow-up periods.