Injury is the leading cause of death and functional disability in adolescent children. Little is known about quality of life and psychological outcomes after trauma in adolescents. The Trauma Recovery Project in Adolescents is a prospective epidemiologic study designed to examine multiple outcomes after major trauma in adolescents aged 12 to 19 years, including quality of life (QoL) and psychological sequelae such as acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). The specific objectives of the present report are to examine ASD rates and the association of ASD with QoL outcomes in injured adolescents.
Between April 26, 1999, and November 13, 2002, 401 eligible trauma patients aged 12 to 19 years triaged to five participating trauma center hospitals in a regionalized trauma system were enrolled in the study. The admission criteria for patients were as follows: (1) age 12 to 19 years and (2) injury diagnoses excluding severe traumatic brain injury (TBI) or spinal cord injury. QoL after trauma was measured using the Quality of Well-being (QWB) scale, a sensitive and well-validated functional index (range, 0 = death to 1.000 = optimum functioning). ASD (before discharge) was diagnosed with the Impact of Events Scale-Revised. Scores of 24+ were used to diagnose ASD. Patient outcomes were assessed at discharge and at 3, 6, 12, 18, and 24 months after discharge.
ASD before discharge was diagnosed in 40% of adolescent trauma survivors. ASD status was associated with large QoL deficits during follow-up, as follows: 3-month, ASD-positive QWB score = 0.667 vs. ASD-negative QWB score = 0.710, p < 0.01; 6-month, ASD-positive QWB score = 0.704 vs. ASD-negative QWB score = 0.742, p < 0.001; 12-month: ASD-positive QWB score = 0.718 vs. ASD-negative QWB score = 0.757, p < 0.01; 24-month, ASD-positive QWB score = 0.725 vs. ASD-negative QWB score = 0.769, p < 0.01. Female sex and violent mechanism predicted ASD risk (47% female vs. 36% male; odds ratio, 1.6; p < 0.05; violence 54% vs. 38%; odds ratio, 1.9; p < 0.01).
Adolescent trauma survivors have high rates of ASD. ASD severely impacts QoL outcomes and is associated with female sex and mechanism of injury in adolescents. Early recognition and treatment of ASD in seriously injured adolescents will improve QoL outcomes.
" OI underscores the importance of identifying children and adolescents at risk for developing clinically significant neuropsychological morbidity such as Acute Stress Disorder and Post Traumatic Stress Disorder since these disorders have been shown to strongly impact short - and long - term measures of quality of life in children and adolescents ( Holbrook et al . 2005 ) . More recent studies of neuropsychological sequelae following OI in children and adolescents have evaluated post traumatic symptoms of stress and elevated anxiety levels ( Jonovska et al . 2008 ) . These sequelae were presumed to be related to the hospitalization and / or specific procedures involved , as symptoms were markedly reduc"
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury (TBI) and orthopedic injury (OI) patients are prone to anxiety and mood disorders. In the present study, we integrated anatomical and diffusion tensor neuroimaging to investigate structural properties of the amygdala and hippocampus, gray matter regions implicated in anxiety and mood disorders. Children and adolescents were evaluated during the late sub-acute phase of recovery following trauma resulting from either moderate to severe TBI or OI. Mean diffusivity (MD) of the amygdala and hippocampus was elevated following TBI. An interaction of hemisphere, structure, and group revealed that MD of the right amygdala was elevated in females with TBI. Self-reported anxiety scores were not related to either volume or microstructure of the hippocampus, or to volume or fractional anisotropy of the amygdala. Left amygdala MD in the TBI group accounted for 17.5% of variance in anxiety scores. Anxiety symptoms may be mediated by different mechanisms in patients with TBI or OI.
"Despite the high success rate of non-operative management of solid organs trauma in children, pancreatic injuries particularly those with ductal disruption still pose a major challenge for pediatric surgeons. Due to the high rate of subsequent complications and the need for multiple interventions most authors focus on mortality and long term morbidities as the main outcomes.[1–478] However, our better understanding of health care outcomes would take into account other parameters such as patients and parents’ experiences in addition to the cost of provided care. "
[Show abstract][Hide abstract] ABSTRACT: The presence of ductal disruption in pancreatic trauma is a major indicator of severity leading to higher morbidities and prolonged hospital stay. However, the adoption of early interventional approach in selected cases of documented grade III pancreatic trauma could result in shorter hospitalization and early recovery. We are describing our approach of early presentation-tailored interventions in managing two consecutive children diagnosed with grade III pancreatic injuries, which constitute the two main ends of the presentations' spectrum. For the early presenter a spleen preserving distal pancreatectomy was performed, while for the late presenter with large symptomatic pseudocyst endoscopic drainage was attempted. Both early and late presenting children had quick and uneventful recoveries leading to 5 and 6 days of hospitalization, respectively. Both cases continued to be asymptomatic at 4 and 12 months post procedure. In the pseudocyst case, the gastro-cystostomy stents were removed after 10 weeks, and 2.5 months later a completely healed pancreas was demonstrated by magnetic resonance cholangio-pancreatography. Unlike other abdominal solid organ injuries in children, adopting early presentation-tailored intervention can be associated with quicker recovery and short hospitalization for grade III pancreatic injuries. While the series is still small, achieving such remarkable outcomes in two consecutive cases is possible and could set a new trend in managing these injuries in children.
Saudi Journal of Gastroenterology 04/2011; 17(5):363-6. DOI:10.4103/1319-3767.84500 · 1.12 Impact Factor
"Exposure to terror attacks has been found to negatively impact other mental health domains, such as depression, bereavement, physical health, functioning, and disability (e.g., Galea et al., 2002; Neria et al., 2007; Neria et al., 2008; Silver et al., 2002; Stout, 2002). Although the association of PTSD with reduced quality of life has been examined in a number of civilian populations (e.g., Holbrook et al., 2005; Paunovic & .. Ost, 2004) and war veteran populations (e.g., Zatzick et al., 1997), it has been suggested that more research is needed to better understand the relationships between PTSD and quality of and satisfaction with life (e.g., Howgego et al., 2005; Rapaport, Clary, Fayyad, & Endicott, 2005). Over the last three decades, satisfaction with life has emerged as a central domain of the construct of subjective well-being and quality of life (Diener, Suh, Lucas, & Smith, 1999; Staudinger, Fleeson, & Baltes, 1999), and has been hypothesized to be distinct from " affective " appraisals (e.g., mood and affect symptoms), in that it is more cognitively driven than emotionally driven (see, e.g., Diener, Oishi, & Lucas, 2003; Pavot & Diener, 2004). "
[Show abstract][Hide abstract] ABSTRACT: Few studies have examined the consequences of exposure to ongoing missile attacks in civilian populations. The authors examine the relationships between such exposure, and posttraumatic stress disorder (PTSD), satisfaction with life, and prejudicial attitudes toward the adversary. By using a stratified probability sampling, 160 adults, exposed to repeated missile attacks in southern Israel, were compared to 181 adults from areas outside the range of these attacks. Exposed participants reported more PTSD symptoms and less satisfaction with life, as compared to unexposed participants. The associations between PTSD and satisfaction with life and between PTSD and prejudicial attitudes were significantly stronger among the exposed participants, as compared to those who were not exposed to the attacks. Theoretical and clinical implications of the findings are discussed.
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