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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 22 of 22 Research Studies DisplayedLuther M, Poppert Cordts KM, Williams CN
Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery.
This is a systematic review to quantify sleep wake disturbances (SWD) after pediatric traumatic brain injury (TBI). These SWD can place children at risk for worse outcomes since sleep is needed for brain development and healing after injury. They also evaluated interventions for SWD and the association between SWD and other post-traumatic outcomes. Literature was searched from 1999-2019 evaluating sleep or fatigue in children hospitalized for TBI. Two independent reviewers assessed quality of the studies using the Newcastle-Ottowa Score for observational studies. Out of 966 identified articles, 126 full text articles were reviewed and 24 studies were included. Studies showed at least 20% of children with TBI had some degree of SWD including trouble falling or staying asleep, fatigue, daytime fatigue, and nightmares. SWD was negatively correlated with cognitive, behavioral, and quality of life outcomes. There was moderate-high risk of bias for all studies due to small sample size and lack of validated or objective SWD measures.
AHRQ-funded; HS022981.
Citation: Luther M, Poppert Cordts KM, Williams CN .
Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery.
Sleep 2020 Oct;43(10):zsaa083. doi: 10.1093/sleep/zsaa083..
Keywords: Children/Adolescents, Sleep Problems, Brain Injury, Neurological Disorders, Trauma, Risk, Patient-Centered Outcomes Research, Outcomes, Quality of Life, Evidence-Based Practice
Otto L, Wang A, Wheeler K
Comparison of manual and computer assigned injury severity scores.
The study objective was to compare the ISS manually assigned by hospital personnel and those generated by the ICDPIC software for value agreement and predictive power of length of stay (LOS) and mortality. The investigators found that the LOS and mortality predictive power were significantly higher for manually assigned ISS when compared with computer assigned ISS in both PTC and NTDB data sets. They indicated that hospitals should be cautious about transitioning to computer assigned ISS, specifically for patients who are critically injured.
AHRQ-funded; HS024263.
Citation: Otto L, Wang A, Wheeler K .
Comparison of manual and computer assigned injury severity scores.
Inj Prev 2020 Aug;26(4):330-33. doi: 10.1136/injuryprev-2019-043224..
Keywords: Health Information Technology (HIT), Injuries and Wounds, Trauma, Hospitals
Johnson BN, Lumley MA, Cheavens JS
Exploring the links among borderline personality disorder symptoms, trauma, and pain in patients with chronic pain disorders.
The authors compared study participants high or low on borderline personality disorder (BPD) symptoms on patterns of pain experience and types of child and adult traumas. They found that BPD symptoms were associated with increased clinical severity among patients with chronic pain as well as a unique manifestation of pain experiencing. Childhood trauma of all types is associated with chronic pain and BPD co-occurrence. They recommended that researchers and clinicians assess for BPD in people with chronic pain to enhance conceptual models of the transaction between these disorders and to improve clinical care.
AHRQ-funded; HS022990.
Citation: Johnson BN, Lumley MA, Cheavens JS .
Exploring the links among borderline personality disorder symptoms, trauma, and pain in patients with chronic pain disorders.
J Psychosom Res 2020 Aug;135:110164. doi: 10.1016/j.jpsychores.2020.110164..
Keywords: Behavioral Health, Trauma, Pain, Chronic Conditions
Darling KE, Ranzenhofer LM, Hadley W
Negative childhood experiences and disordered eating in adolescents in a weight management program: the role of depressive symptoms.
This cross-sectional study examined the association between stressful life events and weight-related outcomes including weight status, disordered eating behaviors, and insulin sensitivity in treatment-seeking adolescents with overweight and obesity. The authors were also looking at the potential mediating role of depression. The study included 170 adolescents (mean age 14.8, 62% female) enrolled in an interdisciplinary weight management program. Findings were that stressful childhood experiences were significantly related to weight status and disordered eating but not insulin sensitivity. Depressive symptoms were related to stressful experiences and disordered eating patterns but not weight status or insulin sensitivity.
AHRQ-funded; HS027071.
Citation: Darling KE, Ranzenhofer LM, Hadley W .
Negative childhood experiences and disordered eating in adolescents in a weight management program: the role of depressive symptoms.
Eat Behav 2020 Aug;38:101402. doi: 10.1016/j.eatbeh.2020.101402..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Stress, Depression, Behavioral Health, Trauma
Porter A, Brown CC, Tilford JM
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
This study’s objective was to determine if a health insurance disparity exists among pediatric patients with severe traumatic brain injury using data from the National Trauma Data Bank. The Bank contains data from more than 800 trauma centers in the United States. Isolated traumatic brain injury was defined as patients with a head Abbreviated Injury Scale score of 3+. Procedure codes were used to identify four primary treatment approaches combined into 2 classifications: craniotomy or craniectomy and external or intracranial ventricular draining. Condition at admission was defined including hypotension, Glasgow Coma Scale, mechanism and intent of injury, and Injury Severity Scale. Among the cohort of 12,449 patients, 91% had insurance and 9% were uninsured. Children without insurance had worse condition at admission with higher rates of hypotension and higher Injury Severity Score when compared with publicly and privately insured patients. Having insurance was associated with a 32% increase in the odds of cranial procedures, and 54% increase in the odds of monitor placement. Insurance coverage was associated 25% lower odds of inpatient mortality. Further study is needed to determine what factors lead to worse condition at admission.
Citation: Porter A, Brown CC, Tilford JM .
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
Crit Care Med 2020 Jul;48(7):e584-e91. doi: 10.1097/ccm.0000000000004398..
Keywords: Children/Adolescents, Brain Injury, Trauma, Health Insurance, Access to Care, Uninsured, Outcomes
Morris RS, Davis NJ, Koestner A
Redefining the trauma triage matrix: the role of emergent interventions.
In this retrospective study, researchers compared the effectiveness of the need for an emergent intervention within 6 h (NEI-6) with existing definitions. Using data from the Michigan Trauma Quality Improvement Program, they found that NEI-6 performs better than trauma triage matrix, need for trauma intervention, and secondary triage assessment tool in terms of under-triage, mortality and need for resource utilization. Other methods resulted in significantly more full-tiered trauma team activations than NEI-6 without identifying patients at risk for early mortality. They concluded that NEI-6 represents a novel tool to determine trauma activation appropriateness.
AHRQ-funded; HS026379.
Citation: Morris RS, Davis NJ, Koestner A .
Redefining the trauma triage matrix: the role of emergent interventions.
J Surg Res 2020 Jul;251:195-201. doi: 10.1016/j.jss.2019.11.011..
Keywords: Trauma, Emergency Department, Healthcare Delivery
Tignanelli CJ, Silverman GM, Lindemann EA
Natural language processing of prehospital emergency medical services trauma records allows for automated characterization of treatment appropriateness.
Incomplete prehospital trauma care is a significant contributor to preventable deaths. Current databases lack timelines easily constructible of clinical events. Temporal associations and procedural indications are critical to characterize treatment appropriateness. Natural language processing (NLP) methods present a novel approach to bridge this gap. In this study, the investigators sought to evaluate the efficacy of a novel and automated NLP pipeline to determine treatment appropriateness from a sample of prehospital EMS motor vehicle crash records.
AHRQ-funded; HS026379.
Citation: Tignanelli CJ, Silverman GM, Lindemann EA .
Natural language processing of prehospital emergency medical services trauma records allows for automated characterization of treatment appropriateness.
J Trauma Acute Care Surg 2020 May;88(5):607-14. doi: 10.1097/ta.0000000000002598.
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Keywords: Trauma, Injuries and Wounds, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Quality of Care
Myers SR, DeSimone JD, Lorch SA
US hospital type and proximity to mass shooting events.
This study used data on mass shootings to examine the proximity of adult trauma centers, pediatric trauma centers (TCs), and non–trauma center hospitals to such events. The investigators concluded that based on the data, to ensure the success of trauma care everywhere, all hospitals regardless of TC status should expect and prepare for the eventuality of a mass-casualty event involving both adults and children. All hospitals must be ready to serve as the combat forward-field hospital.
AHRQ-funded; HS023806.
Citation: Myers SR, DeSimone JD, Lorch SA .
US hospital type and proximity to mass shooting events.
JAMA Surg 2020 May;155(5):446-7. doi: 10.1001/jamasurg.2020.0095..
Keywords: Hospitals, Trauma, Emergency Department, Emergency Preparedness
Wooldridge AR, Carayon P, Hoonakker P
Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients.
Hospital-based care of pediatric trauma patients includes transitions between units that are critical for quality of care and patient safety. Using a macroergonomics approach, the investigators identified work system barriers and facilitators in care transitions. They interviewed eighteen healthcare professionals involved in transitions from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU.
AHRQ-funded; HS023837.
Citation: Wooldridge AR, Carayon P, Hoonakker P .
Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients.
Appl Ergon 2020 May;85:103059. doi: 10.1016/j.apergo.2020.103059..
Keywords: Children/Adolescents, Inpatient Care, Transitions of Care, Healthcare Delivery, Trauma, Hospitals
Morris RS, Milia D, Glover J
Predictors of elderly mortality after trauma: a novel outcome score.
Elderly trauma patients are at high risk for mortality, even when presenting with minor injuries. Previous prognostic models are poorly used because of their reliance on elements unavailable during the index hospitalization. The purpose of this study was to develop a predictive algorithm to accurately estimate in-hospital mortality using easily available metrics. A two-tiered scoring system to predict in-hospital mortality was developed: a quick elderly mortality after trauma (qEMAT) score for use at initial patient presentation and a full EMAT (fEMAT) score for use after radiologic evaluation.
AHRQ-funded; HS026379.
Citation: Morris RS, Milia D, Glover J .
Predictors of elderly mortality after trauma: a novel outcome score.
J Trauma Acute Care Surg 2020 Mar;88(3):416-24. doi: 10.1097/ta.0000000000002569..
Keywords: Elderly, Mortality, Trauma, Injuries and Wounds
Williams CN, Hartman ME, McEvoy CT
Sleep-wake disturbances after acquired brain injury in children surviving critical care.
Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. In this prospective cohort study, the investigators aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. The investigators concluded that over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. They indicated that many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep.
AHRQ-funded; HS022981.
Citation: Williams CN, Hartman ME, McEvoy CT .
Sleep-wake disturbances after acquired brain injury in children surviving critical care.
Pediatr Neurol 2020 Feb;103:43-51. doi: 10.1016/j.pediatrneurol.2019.08.010..
Keywords: Children/Adolescents, Brain Injury, Critical Care, Sleep Problems, Trauma, Injuries and Wounds, Neurological Disorders
Fernandez R, Rosenman ED, Olenick J
Simulation-based team leadership training improves team leadership during actual trauma resuscitations: a randomized controlled trial.
This study’s objective was to assess the clinical impact of simulation-based leadership training on team leadership and patient care during trauma resuscitations. A total of 79 second- and third-year residents at the Harborview Medical Center (a level 1 trauma center) were randomized and 360 resuscitations were analyzed. Participant-led actual trauma resuscitations were video recorded and then coded for leadership behaviors and patient care. Then the residents were randomized to a 4-hour simulation-based leadership training (intervention) or standard orientation (control) condition. The leadership behaviors were then scored pre- and post-training. There was a significant difference in post-training leadership behaviors between the intervention and control conditions.
AHRQ-funded; HS022458.
Citation: Fernandez R, Rosenman ED, Olenick J .
Simulation-based team leadership training improves team leadership during actual trauma resuscitations: a randomized controlled trial.
Crit Care Med 2020 Jan;48(1):73-82. doi: 10.1097/ccm.0000000000004077..
Keywords: Teams, Trauma, Simulation, Training, Provider
Humble SS, Wilson LD, McKenna JW
Tracheostomy risk factors and outcomes after severe traumatic brain injury.
The researchers sought to determine risk factors associated with tracheostomy placement after severe traumatic brain injury (TBI) and subsequent outcomes among those who did and did not receive a tracheostomy. They concluded that age and insurance status are independently associated with tracheostomy placement, but not with mortality after severe TBI. Tracheostomy placement is associated with increased survival after severe TBI.
AHRQ-funded; HS013833.
Citation: Humble SS, Wilson LD, McKenna JW .
Tracheostomy risk factors and outcomes after severe traumatic brain injury.
Brain Inj 2016;30(13-14):1642-47. doi: 10.1080/02699052.2016.1199915.
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Keywords: Adverse Events, Brain Injury, Outcomes, Risk, Trauma
Albrecht JS, McCunn M, Stein DM
Sex differences in mortality following isolated traumatic brain injury among older adults.
This retrospective cohort study's objective was to determine the possibility of sex differences in mortality among older adutls following isolated traumatic brain injury (TBI) and to comapre with findings using all TBI. The researchers did not find that women were significantly associated with decreased odds of mortality following isolated TBI.
AHRQ-funded; HS024560.
Citation: Albrecht JS, McCunn M, Stein DM .
Sex differences in mortality following isolated traumatic brain injury among older adults.
J Trauma Acute Care Surg 2016 Sep;81(3):486-92. doi: 10.1097/ta.0000000000001118.
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Keywords: Sex Factors, Trauma, Brain Injury, Mortality, Elderly
Humble SS, Wilson LD, Leath TC
ICU sedation with dexmedetomidine after severe traumatic brain injury.
This study describes the dexmedetomidine dosage and infusion times, as well as the physiological parameters, neurological status and daily narcotic requirements before, during and after dexmedetomidine infusion. Its findings demonstrate that initiation of dexmedetomidine infusion is not associated with a decline in neurological functioning in adults with severe TBI.
AHRQ-funded; HS013833.
Citation: Humble SS, Wilson LD, Leath TC .
ICU sedation with dexmedetomidine after severe traumatic brain injury.
Brain Inj 2016;30(10):1266-70. doi: 10.1080/02699052.2016.1187289.
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Keywords: Adverse Drug Events (ADE), Brain Injury, Intensive Care Unit (ICU), Medication, Trauma
Yen J, Van Arendonk KJ, Streiff MB
Risk factors for venous thromboembolism in pediatric trauma patients and validation of a novel scoring system: the risk of clots in kids with trauma score.
The researchers identified risk factors for venous thromboembolism and developed venous thromboembolism risk assessment models for pediatric trauma patients. They found that venous thromboembolism is infrequent after trauma in pediatric patients, and they developed weighted scoring systems to stratify pediatric trauma patients at risk.
AHRQ-funded; HS017952.
Citation: Yen J, Van Arendonk KJ, Streiff MB .
Risk factors for venous thromboembolism in pediatric trauma patients and validation of a novel scoring system: the risk of clots in kids with trauma score.
Pediatr Crit Care Med 2016 May;17(5):391-9. doi: 10.1097/pcc.0000000000000699.
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Keywords: Blood Clots, Children/Adolescents, Risk, Risk, Trauma
Shaw JJ, Psoinos CM, Santry HP
It's all about location, location, location: A new perspective on trauma transport.
The objective of this study was to determine the effect of aeromedical transport on trauma mortality when accounting for geographic factors. It concluded that helicopter transport does not impart a survival benefit for trauma patients when geographic considerations are taken into account.
AHRQ-funded; HS022694.
Citation: Shaw JJ, Psoinos CM, Santry HP .
It's all about location, location, location: A new perspective on trauma transport.
Ann Surg 2016 Feb;263(2):413-8. doi: 10.1097/sla.0000000000001265..
Keywords: Trauma, Emergency Medical Services (EMS), Registries, Mortality, Access to Care
Newgard CD, Lowe RA
Cost savings in trauma systems: The devil's in the details.
The authors comment on an article in the same issue of Annals by Zocchi et al. They argue that it makes an important contribution to trauma research and health policy by addressing the question: Can we potentially save money in trauma systems without compromising outcomes by redirecting patients with minor to moderate injuries away from major trauma centers?
AHRQ-funded; HS023796.
Citation: Newgard CD, Lowe RA .
Cost savings in trauma systems: The devil's in the details.
Ann Emerg Med 2016 Jan;67(1):68-70. doi: 10.1016/j.annemergmed.2015.06.025..
Keywords: Healthcare Costs, Trauma, Mortality, Care Coordination, Injuries and Wounds
Vogel JA, Newgard CD, Holmes JF
Validation of the Denver emergency department trauma organ failure score to predict post-injury multiple organ failure.
The objective of the study was to externally validate the Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score, a 6-item instrument that includes age, intubation, hematocrit, systolic blood pressure, blood urea nitrogen, and white blood cell count, which was designed to predict the development of multiple organ failure (MOF) within 7 days of hospitalization. It was determined that the Denver ED TOF Score predicted development of MOF within 7 days of hospitalization.
AHRQ-funded; HS017526; HS023901.
Citation: Vogel JA, Newgard CD, Holmes JF .
Validation of the Denver emergency department trauma organ failure score to predict post-injury multiple organ failure.
J Am Coll Surg 2016 Jan;222(1):73-82. doi: 10.1016/j.jamcollsurg.2015.10.010.
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Keywords: Emergency Department, Trauma, Decision Making, Risk, Injuries and Wounds
Cook JM, Newman E
A consensus statement on trauma mental health: the New Haven Competency Conference process and major findings.
The purpose of this article was to state the need for a comprehensive model of trauma-focused, empirically informed competencies for psychiatrists, and describe the work resulting from the New Haven Competencies consensus conference. The 60 participating experts outlined 5 broad foundational and functional competencies in the areas of trauma-focused and trauma-informed scientific knowledge, psychosocial assessment, psychosocial interventions, professionalism, and relational and systems. Eight cross-cutting competencies were voted into the resulting consensus statement.
AHRQ-funded; HS021602.
Citation: Cook JM, Newman E .
A consensus statement on trauma mental health: the New Haven Competency Conference process and major findings.
Psychol Trauma 2014 Jul;6(4):300-07. doi: 10.1037/a0036747..
Keywords: Trauma, Behavioral Health, Evidence-Based Practice, Education: Continuing Medical Education, Training
Cleveland N, Colwell C, Douglass E
Motor vehicle crash severity estimations by physicians and prehospital personnel.
The purpose of this study was to determine whether emergency physicians (EPs) and EMS personnel differ in their assessment of motor vehicle collision severity and the potential for serious injury when viewing crash scene photographs. They found excellent crash and injury agreement at both ends of the severity spectrum but only modest agreement, and therefore greater variability, in the middle of the severity spectrum.
AHRQ-funded; HS017526
Citation: Cleveland N, Colwell C, Douglass E .
Motor vehicle crash severity estimations by physicians and prehospital personnel.
Prehosp Emerg Care. 2014 Jul-Sep;18(3):402-7. doi: 10.3109/10903127.2014.891065..
Keywords: Emergency Medical Services (EMS), Trauma, Injuries and Wounds, Provider: Health Personnel, Diagnostic Safety and Quality
Band RA, Salhi RA, Holena DN
Severity-adjusted mortality in trauma patients transported by police.
Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. In this retrospective cohort study, the investigators conduct a large, multiyear, citywide analysis of this policy. They examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia.
AHRQ-funded; HS017960.
Citation: Band RA, Salhi RA, Holena DN .
Severity-adjusted mortality in trauma patients transported by police.
Ann Emerg Med 2014 May;63(5):608-14.e3. doi: 10.1016/j.annemergmed.2013.11.008..
Keywords: Injuries and Wounds, Mortality, Patient-Centered Outcomes Research, Trauma