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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 11 of 11 Research Studies DisplayedAghaei P, Bayramzadeh S
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
This study’s objective was to investigate how trauma team members perceive technological equipment and tools in the trauma room (TR) environment and to identify how the technological equipment could be optimized in relation to the TR’s space. The authors conducted a total of 21 focus group sessions with 69 trauma team members, all of whom worked in Level I TRs from six teaching hospitals in the USA. Findings were analyzed and categorized into three parent themes: imaging equipment, assistive devices, and room features. The results suggest that trauma team members place high importance on the availability and versatility of the technological equipment in the TR environment. CT-scanners were not usually optimized for easy access to the TR. Other suggestions included the implementation of cameras and screens to accommodate situation awareness, and the rapid sharing of data such as imaging results. This study will inform health-care designers with the knowledge they need to make informed decisions when designing TRs. It covers key considerations such as room layout, equipment selection, lighting and controls.
AHRQ-funded; HS027261.
Citation: Aghaei P, Bayramzadeh S .
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
Facilities 2024 Mar 12. 2024/02/14..
Keywords: Workflow, Teams, Emergency Department, Trauma
Scaife JH, Bryce JR, Iantorno SE
Secondary undertriage of pediatric trauma patients across the United States emergency departments.
The term “Undertriage” refers to the treatment of patients at facilities lacking in the equipment needed to treat the patient's injuries appropriately. The purpose of this retrospective cohort study was to assess the relationship between patient and hospital characteristics and secondary undertriage in children after major trauma. The researchers utilized the 2019 Nationwide Emergency Department Sample and included patients aged less than 18 years of age if they presented to a Level 3 or non-trauma center (NTC) and were diagnosed with a traumatic injury with an injury severity score of greater than 15 based on International Classification of Diseases 10 codes. The study found that of 6,572 weighted patients, 15% were undertriaged. Undertriage was significantly associated with older age, metropolitan location, and major abdominal injuries. After multivariable adjustment, secondary undertriage was significantly associated with patients aged 6-10 years of age compared to patients aged 15-17 years, penetrating injury, major chest injury, and presentation at a teaching hospital.
AHRQ-funded; HS025776.
Citation: Scaife JH, Bryce JR, Iantorno SE .
Secondary undertriage of pediatric trauma patients across the United States emergency departments.
J Surg Res 2024 Jan; 293:37-45. doi: 10.1016/j.jss.2023.07.054..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Trauma, Injuries and Wounds
Scott JW, Knowlton LM, Murphy P
Financial toxicity after trauma and acute care surgery: from understanding to action.
The negative impact of major injuries and surgical emergencies on patients’ long-term financial wellbeing is a factor that is often overlooked by clinicians and researchers. The concept of financial toxicity includes the objective financial repercussions of illness and medical care and also subjective financial concerns of patients. The purpose of this review was to 1) provide a conceptual overview of financial toxicity after trauma or emergency surgery, 2) outline what is known about the long-term economic outcomes among trauma and emergency surgery patients, 3) examine the relationship between financial toxicity and long-term physical and mental health outcomes, 4) describe policies and programs that may mitigate financial toxicity, and 5) identify the current knowledge gaps and urgent next steps for clinicians and researchers engaged in this area of work.
AHRQ-funded; HS028672.
Citation: Scott JW, Knowlton LM, Murphy P .
Financial toxicity after trauma and acute care surgery: from understanding to action.
J Trauma Acute Care Surg 2023 Nov 1; 95(5):800-05. doi: 10.1097/ta.0000000000003979..
Keywords: Healthcare Costs, Trauma, Surgery
Held P, Splaine CC, Smith DL
Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection.
The purpose of this study was to examine negative post-trauma cognitions (NPCs) change trajectories in individuals who were determined to be non-optimally responsive to intensive PTSD treatment. The researchers utilized a 3-week Cognitive Processing Therapy-based intensive PTSD treatment (ITP) sample of 243 participants. Analyses were replicated in a separate 2-week ITP sample of 215 participants. The study found that in both non-optimal responder samples, two trajectories emerged; a no NPC change group which represented those with an overall lack of NPC change throughout treatment and an NPC change group which represented those with an overall reduction of NPCs occurring primarily later in treatment. Changes in PTSD symptom severity during treatment was the only consistent predictor of NPC change trajectory group membership among treatment non-optimal responders across ITPs.
AHRQ-funded; HS028511.
Citation: Held P, Splaine CC, Smith DL .
Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection.
Eur J Psychotraumatol 2023; 14(2):2237361. doi: 10.1080/20008066.2023.2237361..
Keywords: Trauma, Behavioral Health, Stress
Jones EK, Ninkovic I, Bahr M
A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic rib fractures.
This study’s objective to investigate if a traumatic rib fracture clinical decision support system (CDSS) reduced hospital length of stay (LOS), 90-day and 1-year mortality, unplanned ICU transfer, and the need for mechanical ventilation. The CDSS included an admission evidence-based (EB) order set and a pain-inspiratory-cough (PIC) score early warning system (EWS). The CDSS was implemented at 9 US trauma centers, with 3,279 patients meeting inclusion criteria. Hospital LOS pre vs post-intervention was unchanged but unplanned transfer to the ICU was reduced, as was 1-year mortality. Provider utilization was associated with significantly reduced LOS. The EWS triggered on 34.4% of patients; however, it was not associated with a significant reduction in hospital LOS.
AHRQ-funded; HS026379.
Citation: Jones EK, Ninkovic I, Bahr M .
A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic rib fractures.
J Trauma Acute Care Surg 2023 Aug 1; 95(2):161-71. doi: 10.1097/ta.0000000000003866..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Evidence-Based Practice, Injuries and Wounds, Trauma
Nguyen JK, P P
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
This study’s objective was to compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults. The authors used claims of 100% of 2012-2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma. They assessed the roles of prehospital care, hospital quality, and volume. Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 pp for falls and 2.3 pp for motor vehicle crashes. Outcomes were similar at level 1 and 2 trauma centers. The difference was not explained by hospital quality and volume. There were also no statistical differences in the ambulance-transported group, after adjusting for prehospital variables.
AHRQ-funded; HS025720.
Citation: Nguyen JK, P P .
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
Health Serv Res 2023 Aug; 58(4):817-27. doi: 10.1111/1475-6773.14148..
Keywords: Elderly, Trauma, Outcomes, Injuries and Wounds, Emergency Department, Hospitals
Morrow EL, Mayberry LS, Duff MC
The growing gap: a study of sleep, encoding, and consolidation of new words in chronic traumatic brain injury.
Evidence from neuroscience emphasizes sleep as a crucial support for longitudinal memory and word learning. In numerous lab-based word learning experiments, participants encode and then retrieve new words within the same session. Single session designs are not adequate for capturing the full word learning process. Single session studies also inhibit exploration of the role of behavioral and lifestyle factors such as sleep in supporting longitudinal word learning. Adults with a history of traumatic brain injury (TBI), who experience challenges in the memory systems that support word learning and report related sleep disturbance, provide a unique opportunity to explore linkages between memory, sleep, and word learning. The purpose of this study was to evaluate longitudinal word learning and the influence of sleep on short- and long-term word recall in 50 adults with chronic moderate-severe traumatic brain injury (TBI) and 50 demographically matched neurotypical peers. Participants took part in the study over a two week period in their homes in an attempt to capture the process of real-world word learning and to measure sleep within normal living conditions. The study found that participants with TBI demonstrated a deficit in word learning that started at encoding, continued across time, and increased over the course of the week. The gap in performance between groups was greater at the 1-week post-test than the immediate post-test. Participants with and without TBI recalled more words when they slept after learning.
AHRQ-funded; HS026122.
Citation: Morrow EL, Mayberry LS, Duff MC .
The growing gap: a study of sleep, encoding, and consolidation of new words in chronic traumatic brain injury.
Neuropsychologia 2023 Jun 6; 184:108518. doi: 10.1016/j.neuropsychologia.2023.108518..
Keywords: Brain Injury, Chronic Conditions, Sleep Problems, Trauma
Stonko DP, Weller JH, Gonzalez Salazar AJ
A pilot machine learning study using trauma admission data to identify risk for high length of stay.
The purpose of this study was to design a tool that used only data available at time of admission for trauma to predict prolonged hospital length of stay (LOS). Data was collected from the trauma registry at an urban level-one adult trauma center. Single layer and deep artificial neural networks were trained to identify patients in the top quartile of LOS and optimized under the receiver operator characteristic curve. The results indicated that machine learning can predict which trauma patients will have prolonged LOS with physiologic and demographic data available at the time of admission. The authors concluded these patients may benefit from additional disposition planning resources at the time of admission.
AHRQ-funded; HS026640; HS024547; HS027793.
Citation: Stonko DP, Weller JH, Gonzalez Salazar AJ .
A pilot machine learning study using trauma admission data to identify risk for high length of stay.
Surg Innov 2023 Jun; 30(3):356-65. doi: 10.1177/15533506221139965..
Keywords: Trauma, Hospitalization, Health Information Technology (HIT)
Goldstein E, King C, Crits-Cristoph P
The association between trauma and interpersonal problems in a United States community mental health setting.
Prior studies have established connections between traumatic experiences and issues in interpersonal relationships. The purpose of this study was to explore the influence of trauma on interpersonal difficulties in depressed individuals seeking assistance within a community mental health framework. The study included 453 patients who sought treatment and were screened for a comparative effectiveness analysis of depression therapies. The relationship between the 32-item Inventory of Interpersonal Problems (IIP-32) and trauma indicators was investigated. The study found that a staggering 99.1% of participants had undergone a traumatic event. Notable correlations were identified between the total count of traumas, the number of sexually and physically abusive traumas, and factors such as gender and ethnicity. The number of sexually abusive traumas demonstrated a significant connection to the IIP-32 "excessively nurturing" subscale. After adjusting for demographic variables and other IIP-32 subscales, the overall number of traumas retained a significant association with the IIP-32 "excessively nurturing" category.
AHRQ-funded; HS018440
Citation: Goldstein E, King C, Crits-Cristoph P .
The association between trauma and interpersonal problems in a United States community mental health setting.
J Clin Psychol 2023 Apr;79(4):1192-207. doi: 10.1002/jclp.23467.
Keywords: Trauma, Behavioral Health, Community-Based Practice
Kaufman EJ, Khatri U, Hall EC
Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma.
This study surveyed members of the American Association for the Surgery of Trauma (AAST) to assess their perspectives on frequency, circumstances, and implications of law enforcement officer (LEO) presence in trauma bays nationwide. The survey was distributed electronically to AAST members in September and October 2020, with 234 responding. Of those respondents, 189 (80.7%) were attending surgeons, 169 (72.2%) identified as white, and 144 (61.5%) as male. 187 respondents (79.9%) observed LEO presence at least weekly. Respondents found LEOs helpful for public safety, followed by clinical care, and then for patients. Older respondents rated LEO presence as helpful more often than younger respondents. Respondents assessed severity of the patient's condition, the safety of emergency department staff, the safety of LEOs, and a patient's potential role as a threat to public safety when determining LEO access.
AHRQ-funded; HS026372.
Citation: Kaufman EJ, Khatri U, Hall EC .
Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma.
Trauma Surg Acute Care Open 2023 Mar 13;8(1):e001022. doi: 10.1136/tsaco-2022-001022.
Keywords: Trauma, Emergency Department
Wells KB, Skrine Jeffers K, Mango J
Integration of arts and health sciences in developing an opera on veteran resilience and recovery.
This case study describes development of an opera on veteran resilience and recovery that integrated arts and health sciences. The opera libretto was developed using themes informed from deidentified interviews from 280 adults with a history of depression at 10-year follow-up to a randomized trial. The opera was written using the following key themes: a) resilience in the face of stress; b) post-Vietnam depression or anxiety; c) pathways to recovery; and d) a “collage” of coping strategies. Three main lead characters were developed including a lead veteran, the veteran’s wife, and a second veteran.
AHRQ-funded; HS008349.
Citation: Wells KB, Skrine Jeffers K, Mango J .
Integration of arts and health sciences in developing an opera on veteran resilience and recovery.
Health Promot Pract 2023 Mar; 24(2):207-13. doi: 10.1177/15248399211065402..
Keywords: Social Stigma, Trauma, Behavioral Health