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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 25 of 32 Research Studies DisplayedScott JW, Scott KW, Moniz M
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
This cross-sectional study linked insurance claims and consumer credit report data to evaluate the experience of financial distress in commercially insured adults after traumatic injury. Data from Blue Cross Blue Shield of Michigan’s preferred provider organization insurance claims from 2019 through 2021 were included. The authors identified working-age adults aged 21 to 64 whose January 2021 credit reports occurred more than 6 months after hospital admission for traumatic injury. This cohort of 3164 adults was compared demographically to 2223 patients in the comparison cohort. Relative to the comparison cohort, the post injury cohort had a 23% higher likelihood of having medical debt in collections, a 70% higher amount of medical debt in collections, and a 110% higher bankruptcy rate. For many commercially insured patients, the burden of out-of-pocket costs after hospitalization exceeded their ability to pay and could be associated with bankruptcy risk.
AHRQ-funded; HS028672; HS025465; HS028817.
Citation: Scott JW, Scott KW, Moniz M .
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
JAMA Health Forum 2022 Nov;3(11):e224105. doi: 10.1001/jamahealthforum.2022.4105..
Keywords: Trauma, Healthcare Costs, Health Insurance
Bowden CF, Simmel C, Mendez A
The complexity of psychotropic medication prescription and treating trauma among youth in foster care: perspectives from the lived experience.
The purpose of this study was to examine stakeholders' perspectives of the relationship between psychotropic medications and trauma informed care (TIC) for youth in foster care. The researchers recruited foster caseworkers, prescribing clinicians, caregivers, and alumni of the foster care system and conducted semi-structured individual and group interviews. Data were recorded and transcribed verbatim and analyzed using a directed content analysis approach. Five themes emerged across the recorded and transcribed data within stakeholder groups: 1) acknowledging trauma; 2) role of psychotropic medication; 3) psychosocial resources; 4) additional supports; and, 5) training and education. Stakeholders identified TIC as an important component of mental health services for youth in foster care. Most stakeholders felt that psychotropic medication was overused in treating trauma. Respondents suggested including additional supportive team members to help guide youth through the mental health treatment system and stated the importance of support from individuals with common lived experiences. The study concluded that there is a need for: improved training and education for stakeholders, additional sources of support for youth in foster care, and an overall system that emphasizes trauma-sensitive clinical interactions and psychosocial supports.
AHRQ-funded; HS02600101A1.
Citation: Bowden CF, Simmel C, Mendez A .
The complexity of psychotropic medication prescription and treating trauma among youth in foster care: perspectives from the lived experience.
Adm Policy Ment Health 2022 Sep;49(5):821-33. doi: 10.1007/s10488-022-01203-4..
Keywords: Children/Adolescents, Vulnerable Populations, Behavioral Health, Trauma, Medication
Henkhaus LE
The lasting consequences of childhood sexual abuse on human capital and economic well-being.
The objective of this study was to examine impacts on human capital and economic well-being of childhood sexual abuse by estimating likely ranges around causal effects, using a nationally representative U.S. sample. Findings suggested that childhood sexual abuse led to lower educational attainment and worse labor market outcomes. Further, childhood sexual abuse by someone other than a caregiver was as influential or more so than caregiver sexual abuse in predicting worse outcomes.
AHRQ-funded; HS026444.
Citation: Henkhaus LE .
The lasting consequences of childhood sexual abuse on human capital and economic well-being.
Health Econ 2022 Sep;31(9):1954-72. doi: 10.1002/hec.4557..
Keywords: Children/Adolescents, Trauma
Marks MR, Dux MC, Rao V
Treatment patterns of anxiety and posttraumatic stress disorder following traumatic brain injury.
Investigators examined psychotropic medication use and psychotherapy patterns among individuals diagnosed with anxiety disorders and PTSD post-traumatic brain injury (TBI). They found that receipt of pharmacotherapy pre- and post-TBI was considerably more common than receipt of psychotherapy. Individuals diagnosed with anxiety were 66% less likely to receive psychotherapy compared with individuals diagnosed with PTSD. Overall, psychotropic medication use and rates of antidepressant prescription use in the anxiety group were higher compared to those in the PTSD group.
AHRQ-funded; HS024560.
Citation: Marks MR, Dux MC, Rao V .
Treatment patterns of anxiety and posttraumatic stress disorder following traumatic brain injury.
J Neuropsychiatry Clin Neurosci 2022 Summer;34(3):247-53. doi: 10.1176/appi.neuropsych.21040104..
Keywords: Anxiety, Behavioral Health, Trauma, Brain Injury, Treatments, Practice Patterns, Medication
Danan ER, Brunner J, Bergman A
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
The purpose of this study was to determine whether a history of sexual assault in women Veterans is associated with decreased cervical cancer screening completion. The researchers analyzed data from a 2015 survey of 1049 women Veterans who accessed primary care services at 12 Veterans health administration facilities (VA’s) in nine states, and linked responses with electronic health data from the VA system. Fifty-seven percent (616) of women Veterans reported lifetime sexual assault, and those who did so had a greater likelihood of reporting a high level of distress associated with pelvic examinations and delaying a gynecologic exam due to distress. However, in the final adjusted model, there was not a significant association between lifetime sexual assault and reduced odds of cervical cancer screening completion. The study concluded that there was no significant association between sexual assault and gaps in cervical cancer screening completion.
AHRQ-funded; HS026379.
Citation: Danan ER, Brunner J, Bergman A .
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
J Womens Health 2022 Jul;31(7):1040-47. doi: 10.1089/jwh.2021.0237.AHRQ-funded; HS026379..
Keywords: Women, Cancer: Cervical Cancer, Cancer, Screening, Trauma
Neiman PU, Flaherty MM, Salim A
Evaluating the complex association between social vulnerability index and trauma mortality.
Researchers merged CDC Social Vulnerability Index (SVI) data with a statewide trauma registry and employed three analytic models to evaluate the association between SVI quartile and inpatient trauma mortality. Results showed that, while higher SVI was associated with worse mortality in the unadjusted model, there was no significant association between SVI and inpatient mortality after adjusting for covariates common to trauma. Higher SVI was associated with a higher likelihood of presenting with penetrating injuries. These findings suggested that the burden of trauma mortality is not driven by variation in quality of treatment, but by lethality of injuries. The researchers concluded that improvement in trauma survival among high-risk communities will require interventions and policies which target social and structural inequities upstream of trauma center admission.
AHRQ-funded; HS028672; HS027788.
Citation: Neiman PU, Flaherty MM, Salim A .
Evaluating the complex association between social vulnerability index and trauma mortality.
J Trauma Acute Care Surg 2022 May; 92(5):821-30. doi: 10.1097/ta.0000000000003514..
Keywords: Social Determinants of Health, Trauma, Mortality
Maughan BC, Lin A, Caughey AB
Field trauma triage among older adults: a cost-effectiveness analysis.
The authors evaluated the cost-effectiveness of a high-sensitivity triage strategy for older adults. They used a microsimulation model with a retrospective cohort of community-dwelling Medicare beneficiaries transported by emergency medical services after an acute injury. They found that high-sensitivity trauma field triage is not cost-effective among older adults.
AHRQ-funded; HS023796.
Citation: Maughan BC, Lin A, Caughey AB .
Field trauma triage among older adults: a cost-effectiveness analysis.
J Am Coll Surg 2022 Feb 1;234(2):139-54. doi: 10.1097/xcs.0000000000000025..
Keywords: Elderly, Trauma, Healthcare Costs
Hoonakker PLT, Hose BZ, Carayon P
Scenario-based evaluation of team health information technology to support pediatric trauma care transitions.
This study’s objective was to examine if the Teamwork Transition Technology (T(3)) supports teams and team cognition. Using a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T(3), results showed that most participants agreed that the technology helped to achieve the goals set out in the design phase. Respondents thought that T(3) organized and presented information in a different way that was helpful to them. The authors concluded that the results of their evaluation showed that participants agreed that T(3) does support them in their work and increases their situation awareness.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Hose BZ, Carayon P .
Scenario-based evaluation of team health information technology to support pediatric trauma care transitions.
Appl Clin Inform 2022 Jan;13(1):218-29. doi: 10.1055/s-0042-1742368.
AHRQ-funded; HS023837..
AHRQ-funded; HS023837..
Keywords: Children/Adolescents, Transitions of Care, Health Information Technology (HIT), Teams, Trauma
Rudd BN, Last BS, Gregor C
Benchmarking treatment effectiveness of community-delivered trauma-focused cognitive behavioral therapy.
The objectives of the current study are to (a) evaluate the effectiveness of trauma-focused cognitive behavioral therapy (TF-CBT) delivered from 2013 to 2016 in 15 behavioral health agencies on youth PTSD as well as general mental health symptoms and functioning, and (b) benchmark these clinical outcomes against other published efficacy and effectiveness trials. This study is the first benchmarking study of TF-CBT and provides preliminary findings with regard to the effectiveness, and transportability, of TF-CBT to urban community settings that serve youth in poverty.
AHRQ-funded; HS000084.
Citation: Rudd BN, Last BS, Gregor C .
Benchmarking treatment effectiveness of community-delivered trauma-focused cognitive behavioral therapy.
Am J Community Psychol 2019 Dec;64(3-4):438-50. doi: 10.1002/ajcp.12370..
Keywords: Children/Adolescents, Behavioral Health, Trauma, Stress, Outcomes, Treatments
Kim J, Engelberg RA, Downey L
Predictors of advance care planning documentation in patients with underlying chronic illness who died of traumatic injury.
This study examined predictors of advance care planning (ACP) in patients with underlying chronic illness who died of traumatic injury. Death records and electronic health records were used to identify decedents with chronic life-limiting illness who died between 2010 and 2015. Only 22% of decedents at ACP documentation at the time of their traumatic injury. Patients who were older, had more chronic illnesses and more nonsurgical hospitalizations were more likely to have completed ACP documentation in the year before injury. After injury, only 4% completed ACP documentation who did not have it before.
AHRQ-funded; HS022982.
Citation: Kim J, Engelberg RA, Downey L .
Predictors of advance care planning documentation in patients with underlying chronic illness who died of traumatic injury.
J Pain Symptom Manage 2019 Nov;58(5):857-63.e1. doi: 10.1016/j.jpainsymman.2019.07.015..
Keywords: Patient-Centered Healthcare, Trauma, Chronic Conditions
Newgard CD, Caughey A, McConnell KJ
Comparison of injured older adults included in vs excluded from trauma registries with 1-year follow-up.
The purpose of this cohort study was to compare injured older adults who were included in with those excluded from trauma registries, with a focus on patients with serious injuries, requiring major surgery, or dying after injury. Subjects included all injured adults 65 years and older who were transported by 44 emergency medical services agencies to 51 trauma and nontrauma centers in 7 counties in Oregon and Washington. Results showed that, in their current form, trauma registries were ineffective in capturing, tracking, and evaluating injured older adults, although mortality following injury is frequently due to noninjury causes. High-risk injured older adults were not included in registries because of care in nontrauma hospitals, restrictive registry inclusion criteria, and being missed by registries in trauma centers.
AHRQ-funded; HS023796.
Citation: Newgard CD, Caughey A, McConnell KJ .
Comparison of injured older adults included in vs excluded from trauma registries with 1-year follow-up.
JAMA Surg 2019 Sep;154(9):811-18. doi: 10.1001/jamasurg.2019.2279..
Keywords: Elderly, Registries, Trauma
Vadlamani A, Perry JA, McCunn M
Racial differences in discharge location after a traumatic brain injury among older adults.
The purpose of this retrospective cohort study was to determine if there were racial differences in discharge location among older adults treated for traumatic brain injury (TBI) at a level 1 trauma center. The authors concluded that in this group of Medicare-eligible older adults, blacks were more likely to be discharged to inpatient rehabilitation compared to whites.
AHRQ-funded; HS024560.
Citation: Vadlamani A, Perry JA, McCunn M .
Racial differences in discharge location after a traumatic brain injury among older adults.
Arch Phys Med Rehabil 2019 Sep;100(9):1622-28. doi: 10.1016/j.apmr.2019.03.008.
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Keywords: Racial and Ethnic Minorities, Brain Injury, Trauma, Elderly, Hospital Discharge, Rehabilitation, Medicare
Cook JM, Newman E, Simiola V
Trauma training: competencies, initiatives, and resources.
Traumatic stress is currently not a required component of the standard curricula in graduate-level education in clinical and counseling psychology. However, due to the high prevalence of trauma and its potentially deleterious physical and mental health effects in the general and clinical populations, it is imperative that psychology graduate students and practitioners understand the relevance of trauma in their clients' lives and its impact in clinical research. This paper discusses competencies, initiatives and resources related to trauma training.
AHRQ-funded; HS021602.
Citation: Cook JM, Newman E, Simiola V .
Trauma training: competencies, initiatives, and resources.
Psychotherapy 2019 Sep;56(3):409-21. doi: 10.1037/pst0000233..
Keywords: Education: Continuing Medical Education, Behavioral Health, Provider, Stress, Training, Trauma
Wooldridge A, Carayon P, Hoonakker P
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, the investigators combined interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity.
AHRQ-funded; HS023837.
Citation: Wooldridge A, Carayon P, Hoonakker P .
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Cogn Technol Work 2019 Aug;21(3):397-416. doi: 10.1007/s10111-018-0520-0..
Keywords: Care Coordination, Children/Adolescents, Critical Care, Health Services Research (HSR), Healthcare Delivery, Inpatient Care, Patient Safety, Teams, Trauma, Young Adults
Hoonakker PLT, Wooldridge AR, Hose BZ
Information flow during pediatric trauma care transitions: things falling through the cracks.
In order to investigate information flow during pediatric trauma care transitions, researchers interviewed 18 clinicians about communication and coordination between the emergency department, operating room, and pediatric intensive care unit, then surveyed the clinicians about patient safety during these transitions. They found that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To manage the transition of this fragile and complex population better, they recommend finding ways to manage the information flow during these transitions better by, for instance, providing technological support to ensure shared mental models.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Wooldridge AR, Hose BZ .
Information flow during pediatric trauma care transitions: things falling through the cracks.
Intern Emerg Med 2019 Aug;14(5):797-805. doi: 10.1007/s11739-019-02110-7..
Keywords: Children/Adolescents, Communication, Emergency Department, Healthcare Delivery, Intensive Care Unit (ICU), Patient Safety, Provider, Provider: Clinician, Surgery, Transitions of Care, Trauma
Albrecht JS, Al Kibria GM, Greene CR
Post-discharge mortality of older adults with traumatic brain injury or other trauma.
This study examined post-discharge mortality of older adults with traumatic brain injury (TBI) or non-TBI trauma compared with the general population. A retrospective cohort study of adults 65 years and older was conducted using data from an urban trauma center from 1997 to 2008. The data was then linked to the National Death Index through 2008 to obtain date and cause of death. A higher rate of death was associated with both cohorts after moderate to severe injury from accidents than for older adults without TBI or non-TBI trauma.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Al Kibria GM, Greene CR .
Post-discharge mortality of older adults with traumatic brain injury or other trauma.
J Am Geriatr Soc 2019 Jul 25;67(11):2382-86. doi: 10.1111/jgs.16098..
Keywords: Elderly, Hospital Discharge, Injuries and Wounds, Mortality, Trauma
Meagher AD, Lin A, Mandell SP
A comparison of scoring systems for predicting short- and long-term survival after trauma in older adults.
Researchers conducted a retrospective cohort study to identify injured older adults at highest risk for 30-day mortality. They found that older, injured adults transported by EMS to a large variety of trauma and non-trauma hospitals were more likely to die within 30 days if they required emergent airway management or had a higher comorbidity burden. They concluded that identification of an ideal prognostic tool remains elusive.
AHRQ-funded; HS023796.
Citation: Meagher AD, Lin A, Mandell SP .
A comparison of scoring systems for predicting short- and long-term survival after trauma in older adults.
Acad Emerg Med 2019 Jun;26(6):621-30. doi: 10.1111/acem.13727..
Keywords: Elderly, Trauma, Mortality, Injuries and Wounds, Emergency Department
Durojaiye AB, Levin S, Toerper M
Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data.
This study electronic health record (EHR) data to compare usage patterns from pediatric trauma patients with minor injuries at a Level I pediatric trauma center. The data was used to compare demographics, clinical and network characteristics, and emergency department (ED) length of stay (LOS). Three distinct groups were compared: fully connected, partially connected, and disconnected. The fully connected group had a decreased ED LOS compared with the partially connected group.
AHRQ-funded; HS023837.
Citation: Durojaiye AB, Levin S, Toerper M .
Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data.
J Am Med Inform Assoc 2019 Jun;26(6):506-15. doi: 10.1093/jamia/ocy184..
Keywords: Children/Adolescents, Trauma, Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Healthcare Utilization
Pruitt P, Naidech A, Ornam J
A natural language processing algorithm to extract characteristics of subdural hematoma from head CT reports.
Researchers created a natural language processing (NLP) algorithm to predict radiographic characteristics of subdural hematomas (SDH). The NLP was used to extract data from cranial computed tomography (CT) scan reports for patients with SDH. The results were measured for accuracy compared to cranial CT scan interpretations by board-certified attending radiologists and data coded by two ED physicians.. Output performance was considered high, with an algorithm accuracy of 0.84 for side of largest SDH, 0.88 for thickness of largest SDH, and 0.92 for size of midline shift.
AHRQ-funded; HS000078.
Citation: Pruitt P, Naidech A, Ornam J .
A natural language processing algorithm to extract characteristics of subdural hematoma from head CT reports.
Emerg Radiol 2019 Jun;26(3):301-06. doi: 10.1007/s10140-019-01673-4..
Keywords: Diagnostic Safety and Quality, Imaging, Trauma
Vogel JA, Gannon Sungar W, Boatright D
Denver ED Trauma Organ Failure Score predicts healthcare resource utilization in adult trauma patients.
This study examined the success of the Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score and the need for specialized healthcare resources for trauma patients. Outcomes measured included intensive care unit (ICU) length of stay (LOS), hospital LOS, procedures and costs. They included 3000 patients with 71% of them male, a median age of 42, and median injury severity score of 9 (IQR 5-16). Of that total, 46% were admitted to the ICU and 4% died. The tool was found to successfully predict healthcare resource utilization and can be used to identify patients early after injury that will require specialized trauma care.
AHRQ-funded; HS023901.
Citation: Vogel JA, Gannon Sungar W, Boatright D .
Denver ED Trauma Organ Failure Score predicts healthcare resource utilization in adult trauma patients.
Am J Emerg Med 2019 Jun;37(6):1108-13. doi: 10.1016/j.ajem.2018.08.073..
Keywords: Emergency Department, Healthcare Utilization, Outcomes, Trauma
Jarman MP, Pollack Porter K, Curriero FC
Factors mediating demographic determinants of injury mortality.
The authors investigated the role of injury characteristics and access to trauma care as mediators of the relationships between race, ethnicity, sex, and injury mortality. They found that distance, injury characteristics, and insurance mediate the effects of demographic characteristics on injury mortality and appear to contribute to disparities in injury mortality.
AHRQ-funded; HS000029.
Citation: Jarman MP, Pollack Porter K, Curriero FC .
Factors mediating demographic determinants of injury mortality.
Ann Epidemiol 2019 Jun;34:58-64.e2. doi: 10.1016/j.annepidem.2019.03.013..
Keywords: Access to Care, Disparities, Injuries and Wounds, Mortality, Racial and Ethnic Minorities, Sex Factors, Social Determinants of Health, Trauma
Newgard CD, Lin A, Yanez ND
Long-term outcomes among injured older adults transported by emergency medical services.
This study examined the outcomes of injured older adults who were transported by emergency medical services (EMS) to the hospital. Older adults 65 years and older who were transported by 44 EMS agencies to 51 hospitals in 2011 were included and then had a 12-month follow-up through December 31, 2012. The majority of older adults were transported after a fall (84.5%). Serious injuries occurred in 3.5% with a serious extremity injury being the most common (17.8%). Mortality rates for older adults with severe injuries ranged from 1.6% in the hospital to 20.3% at 1 year. The most common causes of death was cardiovascular diseases and dementia.
AHRQ-funded; HS023796.
Citation: Newgard CD, Lin A, Yanez ND .
Long-term outcomes among injured older adults transported by emergency medical services.
Injury 2019 Jun;50(6):1175-85. doi: 10.1016/j.injury.2019.04.028..
Keywords: Elderly, Emergency Medical Services (EMS), Falls, Injuries and Wounds, Outcomes, Trauma
McKernan LC, Johnson BN, Crofford LJ
Posttraumatic stress symptoms mediate the effects of trauma exposure on clinical indicators of central sensitization in patients with chronic pain.
This study examines the relationship between posttraumatic stress disorder (PTSD) and chronic pain involving central sensitization (CS). A sample of 202 patients (79% female) with chronic pain filled out surveys describing their trauma exposure, current PTSD symptoms, experiential avoidance and 3 manifestations of CS which are widespread pain, greater pain severity, and polysomatic symptom reporting. All 3 clinical indicators of CS were significantly associated with trauma exposure and PTSD symptoms. Further investigation is needed on the mediating effect of current PTSD symptoms.
AHRQ-funded; HS022990.
Citation: McKernan LC, Johnson BN, Crofford LJ .
Posttraumatic stress symptoms mediate the effects of trauma exposure on clinical indicators of central sensitization in patients with chronic pain.
Clin J Pain 2019 May;35(5):385-93. doi: 10.1097/ajp.0000000000000689..
Keywords: Chronic Conditions, Behavioral Health, Pain, Trauma
Galganski LA, Cox JA, Greenhalgh DG
Cervical spine injury in burned trauma patients: incidence, predictors, and outcomes.
This study examined incidence, predictors, and outcomes of burned trauma patients with cervical spine injuries (CIs). A retrospective cohort study of patients in the National Trauma Data Bank between 2007 and 2012 was conducted. There were a total of 94,964 patients in the study with 0.79% (745) patients with a diagnosis of CI. The most common mechanism for CI with a burn injury was motor vehicle injury, followed by falls, fire/flame, and explosion. Every year increase in patient age had a 1.05 higher odds of CI. Patients with CI had higher mortality, longer length of stay, intensive care unit length of day, and ventilator days.
AHRQ-funded; HS022236.
Citation: Galganski LA, Cox JA, Greenhalgh DG .
Cervical spine injury in burned trauma patients: incidence, predictors, and outcomes.
J Burn Care Res 2019 Apr 26;40(3):263-68. doi: 10.1093/jbcr/irz022..
Keywords: Trauma, Injuries and Wounds
Glass NE, Vadlamani A, Hwang F
Bleeding and thromboembolism after traumatic brain injury in the elderly: a real conundrum.
The objectives of this study were to evaluate the incidence of bleeding, recurrent traumatic brain injury (TBI), and thromboembolic (TE) events after an initial TBI in older adults and to identify which factors contribute to this risk. The researchers found that, among Medicare patients hospitalized with TBI, the incidence of TE events was significantly higher than that of bleeding or recurrent TBI. They identified specific risk factors of bleeding and TE events, which may guide care of older adults after TBI.
AHRQ-funded; HS024560.
Citation: Glass NE, Vadlamani A, Hwang F .
Bleeding and thromboembolism after traumatic brain injury in the elderly: a real conundrum.
J Surg Res 2019 Mar;235:615-20. doi: 10.1016/j.jss.2018.10.021..
Keywords: Brain Injury, Blood Clots, Elderly, Trauma, Injuries and Wounds, Risk, Adverse Events