Entries in trauma (9)


How Should Doctors Treat Childhood Trauma?

Jupiterimages/Thinkstock(NEW YORK) -- After tragic events involving children, including the Sandy Hook Elementary School shooting in Connecticut and the kidnapping of 5-year-old Ethan by Jimmy Lee Dykes’ in Alabama, researchers are focusing more attention on how to treat children who’ve experienced trauma to avoid post traumatic stress disorder and other psychological repercussions.  But they have few answers on what course of treatment is best.

Researchers Valerie Forman-Hoffman, Dr. Adam Zolotor and the rest of their team set out in 2010 to pull together data from hundreds of studies to determine which medicines and behavioral therapy produced the best results in traumatized children and adolescents. But they were surprised to find that only 25 studies fit the criteria of being large, randomized and controlled.

“We’re seeing more and more of these [traumas] every day, but we don’t have good evidence for how to make decisions for these kids,” said Forman-Hoffman, a psychiatric epidemiologist at RTI International, a research institute in North Carolina. "This topic is so hard to study when you consider the kids involved and what they’re exposed to. The last thing we want to do when kids are involved in a terrible tragedy and traumatic event is come in with clipboards.”

The review, which was published Monday in the journal of the American Academy of Pediatrics, says in its background that two thirds of children experience a traumatic event before they’re 16 years old.  (This comes from a 2007 study that followed 1,420 children for up to seven years.)  A traumatic event could include seeing or being the victim of domestic abuse, experiencing a natural disaster or witnessing a violent act involving strangers.

Although the Pediatrics review revealed that children taking medications for their trauma didn’t experience fewer signs of trauma than those who didn’t, and that children undergoing cognitive behavioral therapy showed some benefit, it’s hard to determine how heavily to weigh the findings, Forman-Hoffman said. There were also no studies that examined treatment-outcome differences between genders, ages or types of trauma.

“It was very, very surprising to me,” she said. “This is a really important topic.  Nobody seems to be talking about how to get these children who are witnesses to these things treatment.”

Forman-Hoffman and Zolotor only examined studies about non-relational trauma, meaning the person (or thing) afflicting the trauma was not a friend or family member of the child. For instance, a non-relational trauma would be a shooting by a stranger or a national disaster, but not a domestic abuse situation.

Zolotor, a family physician and professor at the University of North Carolina School of Medicine, said he embarked on the study because he often treats patients -- children and adults -- who experienced trauma during their childhood.  He’s not sure of the best early treatment, and added that many children don’t fit neatly into the post traumatic stress disorder diagnosis as adults do.  Sometimes, they experience other symptoms of mental illness.

He, too, expected more studies and studies of better quality during the Pediatrics review. He said he hopes his findings prompt more studies to determine how to treat these children in the future.

“The science is quite immature,” he said. “With the recent experience in Newtown, I think we see this over and over again. ...School of public health officials and practices feel the need to do something, and we don’t have a lot of good guidance on what’s the best thing to do.”

Copyright 2013 ABC News Radio


Trauma Surgeons Call for 'War on Ammunition'

iStockphoto/Thinkstock(MIAMI) -- Skyla Davis was shot before she was even born.

Her mother, Tiffany Davis, 27 and eight months pregnant, was leaving a convenience store Dec. 9 in Miami when gang members started shooting in her neighborhood.

One bullet struck her in the brain; another hit her in the abdomen, piercing her womb and shattering her 4-pound baby girl's arm and elbow.

Skyla was delivered by emergency Caesarean section. Her arm is now swaddled in a makeshift sling.

Her mother, unable to speak, was told by doctors about the shooting Monday. Because the bullet shattered in her frontal lobe, which controls much of a person's cognitive function, doctors doubt she'll fully recover.

The bullets were from a Glock 10, the same kind of handgun carried by Adam Lanza, the 20-year-old who fatally shot his mother and then 26 children and staff members at a Newtown, Conn., school Friday before killing himself.

"This epidemic of gun violence is affecting unborn children," said Dr. Tanya Zakrison, who treated Skyla. Zakrison attended an impromptu town hall meeting of trauma surgeons at Ryder Trauma Center at Jackson Memorial Hospital in Miami.

Her hospital, where trauma surgeons bound for Iraq and Afghanistan are trained, is a kind of ground zero in a national crisis.

Last year, 600 gunshot victims -- more than in all of England in a 10-year period -- were treated at Ryder. But Ryder's emergency room is just one piece of a nationwide puzzle.

In 2010, 31,000 Americans were killed by guns -- 60 times more than the number of troops killed in Iraq and Afghanistan in the same year.

About a dozen surgeons who spoke to ABC News -- some of whom said they owned guns themselves for protection -- agreed that they'd like to see guns taken off the streets across the United States, but conceded that it was an impossibility.

"Have all the guns you want," said Dr. Nicholas Namias, medical director of Ryder Trauma Center. "We need a war on ammunition."

Zakrison said she could tell immediately when a victim entered the emergency room whether they'd been hit by an assault weapon or a handgun.

"Absolutely," she said. "[It] looks like a bomb has gone off on the inside."

She said she wants the bullets used today in many semiautomatic weapons to be banned.

Not only do assault rifle bullets travel about three times as fast through the rifle's longer barrel, but they are designed not just to strike but to explode or fragment, causing extensive damage.

Zakrison also said that victims of gun violence needed to be counseled. She said that when drunken drivers caused accidents, they were given counseling with the hope that they don't endanger people again.

She said that patients she saw who'd been wounded by gunfire were often caught in a cycle of violence and were not given that same help.

Copyright 2012 ABC News Radio


Shooting Witnesses: Shock Value Could Add to PTSD Vulnerability

Medioimages/Photodisc(NEW YORK) -- A shooting erupted at the midnight premiere showing of Dark Knight Rises in an Aurora, Colo., theater complex filled with young adults, teenagers and young children with their families, some dressed in playful Batman-genre costumes.

Everyone expected a night of fun; not a massacre. Smoke bombs went off. A gunman stalked victims in the aisles, killing at least 12 people. Witnesses said blood was everywhere.

The surprise, as well as the magnitude of the mass shooting, was enough to trigger post-traumatic stress symptoms in those who were vulnerable, said Dr. Jeffrey A. Lieberman, psychiatrist in chief at New York Presbyterian Hospital-Columbia University Medical Center and director of the New York State Psychiatric Institute.

"On the emotional Richter scale it was very high," he said. "You go to a movie like Batman because it's fun-loving entertainment, and you are seeing kids in costumes and the last thought you are thinking about is some type of seriously dangerous, potentially life-threatening situation. The contrast adds to the potential for emotional trauma."

One witness told ABC News, "You just smelled smoke and you just kept hearing it. You just heard bam bam bam, nonstop. "The gunman never had to reload. Shots just kept going, kept going, kept going."

Psychiatric experts said it was hard to know who would experience serious after-effects of the attack. Only about 7 to 8 percent of all individuals will go on to develop post-traumatic stress disorder, or PTSD, after such an event, according to the Dart Center for Journalism and Trauma.

Most people, if they are not exposed to repeated trauma like war, are resilient and have extraordinary coping skills. But those who are vulnerable can have lifelong effects, said experts.

"We all have our breaking points," said Lieberman. "Everyone, given sufficient stress, like prisoners of war, have different levels of endurance. But events have a residual effect."

Nine miles away in 1999, among those who witnessed the slaughter of 19 students and teachers at Columbine High School in Littleton, Colo., a handful went on to experience repeated nightmares, flashbacks and anxiety-related disorders.

"Even for those people who were not affected, these are peripheral events for people who live in the town and in the state, and they can have an identification from the geography and connection to this," said Lieberman.

About 10 percent of women develop PTSD sometime in their lives compared with 5 percent of men -- about 5.2 million adults in a given year, according to the Department of Veterans Affairs.

Children, it seems, are more resilient than adults.

"It has an impact on them," said Lieberman. "But they have in place readily defined support systems in family and school social structures."

Those who are most prone to PTSD were directly exposed to a traumatic event -- they were either victims or witnesses, or were seriously injured. But one study after the 9/11 attacks found rippling effects on witnesses.

At one school two blocks from the World Trade Center, about 27 percent of staff members who saw a plane fly into one of the towers lost time from work because of physical symptoms, according to a Centers for Disease Control and Prevention study. About one-third reported symptoms consistent with depression.

The degree to which people are affected is determined by their proximity and how sustained or horrific their exposure; their own psychological make-up and the help they receive after the event.

"Your individual vulnerability and resilience is determined by your genetic make-up, and also in part by the psychological features you have developed over the course of your lifetime -- were you confident and successful and could you overcome experiences, or were you cautious and fearful?" said Lieberman.

The best approach for immediate support is a technique called psychological first aid, according to Robin Kerner, director of quality initiative and outcomes at St. Luke's-Roosevelt Hospital Center in New York City.

Rather than asking people to retell their traumatic stories, responders tend to the victims' immediate needs, reassure and comfort them and "perhaps, most importantly, connect them with their social supports.

"Research has shown that the retelling of the traumatic story in the immediate aftermath can lead to retraumatization and does not provide comfort to victims," said Kerner.

The probability of developing PTSD is increased if the victims had direct exposure or were seriously hurt or believed they or their families were in danger. Reactions such as crying, shaking, vomiting, feeling apart from their surroundings or helpless to get out, can be signals, Kerner said.

An earlier life-threatening event, a history of child abuse or mental problems raises the vulnerability level.

Those exposed to the movie theater shooting through images and reports on Twitter may see these posts and feel anxious or worried.

Viewing such events can be "disturbing if not dangerous" for young children, said Dr. Eugene Beresin, director of training in child and adolescent psychiatry at Massachusetts General Hospital in Boston.

"This has largely been seen and studied in a number of situations, such as the Oklahoma City Bombing, the Challenger disaster and the 9/11 attack," he said. "There is considerable evidence that PTSD in kids may develop by watching such events in the media."

Parents can help their children by encouraging them to express their thoughts about the event, and reassure them they are safe. Stick to usual routines, and seek help if the child has distressing dreams of the event or relives the trauma through repetitive play.

Experts recommend that parents limit their children's viewing of television news coverage of the Aurora shooting. Pediatric research shows it can be associated with more long-term distress.

No one is exempt from that emotional distress, say experts.

"One reason is that events such as this are a threat to our assumptive world," said Dr. David J. Schonfeld, director of the National Center for School Crisis and Bereavement at Cincinnati Children's Hospital Medical Center.

"Every day, we make assumptions about our safety and those we care about. Otherwise, we may become overwhelmed by the harsh reality that, at any point, tragedy can happen to those we love," he said. "When something like this event occurs, it forces us to acknowledge that these are assumptions and therefore may not be true. It leaves us feeling vulnerable and unsettled."

Copyright 2012 ABC News Radio


Medical Helicopters: Worth the Cost, Risk?

File photo. Ryan McVay/Thinkstock(NEW YORK) -- Transportation to the hospital by helicopter for trauma patients is linked to a 1.5-percent increased rate of survival compared with ground transportation such as an ambulance, according to a new study published in the Journal of the American Medical Association on Tuesday.

For many this number may seem small. But it means that for every 65 patients taken by helicopter, a life will be saved.

But the flights can be pricey, and -- as a recent surge of medical helicopter crashes shows -- potentially dangerous. According to a report by the National Transportation Safety Board, 2008 saw 12 crashes involving medical helicopters, seven of which were fatal. Medical helicopters have a higher ratio of accidents to number of flight hours than other types of aviation. These potential downsides have some experts concerned that these flights just aren't worth it.

"HEMS [helicopter emergency medical services] is the most dangerous form of helicopter transportation," says Dr. Jeffrey Rabrich, medical director of EMS and disaster preparedness at St. Luke's-Roosevelt Hospital in New York. "They often launch in marginal weather and there have been numerous crashes killing all aboard, including the patient."

The idea of using helicopters to transport ill patients originated in the military with the Vietnam War. The widespread success of medical helicopters in this setting led to the creation of helicopter programs at many hospitals across the world.

In an attempt to show what effect, if any, that helicopters have on survival for trauma patients, the researchers from Johns Hopkins Medical Center studied over 200,000 victims of a wide variety of trauma -- including car crashes, gunshot wounds and workplace accidents -- by using information contained in a national databank. When they matched patients with similar characteristics and similar levels of injury, they found a small increased rate of survival in helicopter-transported patients.

As for how expensive the service is, in Maryland it costs $5,000 for one such flight. Using simple math, the authors estimate the cost to save one life is $325,000. But Maryland has a relatively low operating cost due to the ideal design of their trauma system. In most states the cost per flight is much higher. In some places, the cost per life is over $1 million.

Some doctors say the cost is a necessary expense in some areas where appropriate treatment centers are few and far between.

"The greater Houston area is served by just two level 1 trauma centers for over 5 million people," says Dr. James J. McCarthy, medical director of the emergency center at Memorial Hermann Hospital in Houston.

Yet Dr. Jack Sava, director of trauma at Medstar Washington Hospital Center in Washington D.C., cautions, "Helicopters are not medical treatments, and they are not magic. They're just a fast, expensive way to get to the hospital."

Location appears to play a big part in how useful these helicopters are. In rural areas, where a few medical centers may be scattered over large areas, helicopters can be a real timesaver. But in urban areas where landing a helicopter can be difficult and distances are short, ambulances are often the faster way to go.

"It is generally not recognized by the public that a helicopter is not always faster than an ambulance," says Dr. Amy C. Sisley of Henry Ford Hospital in Detroit, Mich. "Helicopters are often unable to land at the scene of the injury and must land at a distance in a parking lot or other open space."

"I would call a helicopter only if the ground transport time exceeds 60 minutes because less than that and the helicopter isn't saving that much time," Rabrich says. "The helicopters time advantage dissipates rapidly as the distance to the trauma center decreases."

Many experts think the skill level of the crew and superior equipment on helicopters, rather than speed, is what really makes a difference in care. It is not unusual for a helicopter to have a trauma nurse or even a physician on board, something that an ambulance almost never contains.

"In every instance the capabilities typically available on a helicopter will always be the same -- or greater -- than those available in a ground ambulance," explains Dr. Michael A. West, professor of surgery at the University of California San Francisco, referring to this study an "apples to oranges comparison." He says that instead of helicopters, more emphasis should be placed on packing ambulances with better equipment and enhancing paramedic training.

Copyright 2012 ABC News Radio


Scientists to Test Extreme Hypothermia on Pittsburgh Trauma Patients

iStockphoto/Thinkstock(PITTSBURGH) -- It worked on Star Trek, now, researchers are putting a type of suspended animation to the test, investigating whether putting trauma patients into a deep chill might help save their lives.

To test this idea, doctors at the University of Pittsburgh Medical Center will use an experimental technique on Pittsburgh residents who wind up in the trauma center.

The idea is that wounded patients who are bleeding to death can be saved by lowering their body temperature to about 50 degrees.  By inducing hypothermia in these patients, doctors hope to buy time to repair their wounds.

Dr. Samuel Tisherman, a critical care specialist at the University of Pittsburgh Medical Center and the lead researcher of the study, said he hopes the procedure also will give trauma patients a chance to survive without extensive brain damage.

"If a patient is losing a lot of blood and the brain doesn't have oxygen, you can start to see damage after about four or five minutes," Tisherman said.  "If you can cool the brain down fast enough, you could buy 20 minutes, 40 minutes, maybe up to an hour."

Gunshot or stab wounds often cause so much bleeding that patients' hearts stop beating, bringing them into cardiac arrest.  Giving CPR to jumpstart the heart doesn't help because there is not enough blood for the heart to circulate to revive patients.

Operating to repair these wounds is difficult, since the excessive bleeding keeps trauma surgeons from clearly seeing what they're doing.  These patients' chances of survival hover at just 7 percent.

Using extreme hypothermia, doctors would try to slow down a patient's bleeding and put the body's blood-dependent systems on ice.  The deep-chilling process would begin by injecting an ice-cold solution into trauma patients in cardiac arrest.

After about 15 minutes, the patient should be chilled to about 50 degrees, and surgeons can get to work repairing bleeding tissues, ideally taking no more than an hour to finish.  Then patients would be gradually warmed back up again to a normal body temperature.

Tisherman calls the process Emergency Preservation and Resuscitation -- EPR instead of CPR.  The project is receiving funding from the Department of Defense.

Tisherman said the University of Pittsburgh trauma team will use deep-chilling procedure on only about 10 patients initially.  If the treatment works, emergency physicians say it will be a big step forward in treating trauma patients.

Copyright 2011 ABC News Radio


Athletes Rally for Concussion Research

In a photo taken just weeks before his death, Rick Martin (#7) poses with old Buffalo Sabres teammates Rene Robert (#14) and Gilbert Perrault (#11), along with Buffalo Sabres owner Terry Pegula.Rick Stewart/Getty Images(WASHINGTON) -- More than 500 current and former U.S. athletes have agreed to donate their brains to research – a gift they hope will protect future athletes from a progressive brain disease linked to concussions.

Former Buffalo Sabre Rick Martin, who died from a heart attack in March at age 59, is the latest professional athlete to be diagnosed with chronic traumatic encephalopathy – a condition brought on by repeated head trauma with features of Alzheimer's, Parkinson's and Lou Gehrig's disease. Although he had no symptoms, Martin's brain showed tell-tale signs of damage that researchers say would have led to dementia, impulsivity and rage.

"He had relatively mild CTE," said Dr. Ann Mckee, director of neuropathology at the Bedford VA Medical Center and co-director of Boston University's Center for the Study of Traumatic Encephalopathy, where Martin's brain was studied. "At the age of 59, although he had some evidence of this neurodegeneration, it wasn't terribly advanced."

Martin's is one of 96 athlete brains already received by the VA Brain Bank. Of 70 analyzed, more than 50 have shown signs of CTE, including those from 14 of 15 former National Football League players.

But most of the athlete brains at the VA Brain Bank show signs of more severe disease. Like Alzheimer's disease, CTE has stages dictated by the amount and distribution of an abnormal protein called tau in the brain. In the early stages, the protein tends to cluster around blood vessels, later spreading to other "hotspots" in the brain involved in memory, movement and personality.

"As it gets more profound -- and this takes decades, really -- then we definitely see changes in memory, emotionality, even rage behavior," said McKee.

And it gets worse. The disease continues to progress -- albeit more slowly than Alzheimer's disease -- until patients have dementia, disrupted speech and uncoordinated movement.

"In the last three and a half years, we have made dramatic, really remarkable gains in understanding the nature of this disease: how it progresses through the nervous system; what kind of symptom to expect at each stage," said McKee. "The hope is that now that we know what it is we're dealing with, we can really address with research and basic science how to prevent it, how to slow it down or how to cure it."

That's why more than 500 athletes have signed on to donate their brains to the VA Brain Bank.

"I think this is an enormous problem for athletes," said McKee of CTE. "By signing on to this research, they promote their own long-term safety and certainly the safety of future players."

Copyright 2011 ABC News Radio


Study Probes Trauma-Related Deaths in Young Athletes

Comstock/Thinkstock(MINNEAPOLIS) -- As media attention continues to grow over the sudden deaths of young athletes, researchers at the Minneapolis Heart Institute Foundation conducted a study to determine just how many of these fatalities were attributed to trauma in athletes under the age of 21.

After analyzing data from 1980 to 2009, they found that 1,827 young athletes died during this time period, with 261 deaths caused by trauma-related injuries.  The largest number of deaths -- 57 percent -- were football-related.

The authors of the study, which was published Monday in Pediatrics, also determined that head/neck trauma was the most frequent cause of death, with 12 fatalities occurring in boxing and another 10 in football from helmet-to-helmet blows.

They emphasized the “importance of developing more effective equipment design, ...modified blocking/tackling rules, and greater attention to the education of coaches, trainers, parents and athletes regarding the consequences of repeated head blows and concussions.”

Copyright 2011 ABC News Radio


National Children's Mental Health Day Teaches Lessons in Resilience

Jupiterimages/Thinkstock(ROCKVILLE, Md.) -- Resilience was the theme when the Substance Abuse and Mental Health Services Administration (SAMHSA) held its Sixth Annual National Children's Mental Health Day Tuesday.  ABC News spoke with Kathryn Powers, director of the agency's Center for Mental Health Services, who says it's important for Americans to be aware of the high number of children who have been impacted by trauma. 

"More than a quarter of the children in the United States will have been exposed to trauma by time they are four years old," Powers says.

According to Powers, trauma can be defined as either "witnessing or experiencing physical or sexual abuse, violence in families and communities, natural disasters and wartime events or terrorism."

The high number of children exposed to trauma at such young ages is what inspired the agency to choose the resilience theme.  Powers said the goal of the day was to combat the myth that not talking about traumatic experiences with children can prevent the future development of problems.

Powers tells ABC News children don't have to suffer the long-term effects of trauma.

"We hope that people are committed every day of the year, not just on children's mental health awareness day, to make sure that we celebrate the fact that children can and do recover, and can and are resilient no matter what kinds of traumas they have experienced."

Copyright 2011 ABC News Radio


Study: More Trauma Patients Surviving Hospital Stay

Thomas Northcut/Thinkstock(SEATTLE) -- The quality of care received by injured patients on the scene and in hospital trauma centers plays an important role in their ability to leave the hospital alive. A new study of trauma patients finds that many more are surviving their hospital stay, however, survival rates at three years for these patients are lower than expected. 

An ambulance is often the quickest way to transport an injured patient to the hospital for treatment. Once inside a trauma center, that treatment is critical to their overall survival.

Researchers in Washington state found patients who die from their injuries while in the hospital decreased from eight percent in 1995 to about five percent in 2008. "That's the good news. So many more patients survive the hospital stay and get discharged," says Dr. Sam Arbabi from Harborview Medical Center, in Seattle and co-author of the study. He then wanted to know where these patients go after leaving the hospital and what their long-term survival rates are. Researchers analyzed statewide trauma records that were linked to death certificate data over a period of 14 years. "Overall trauma patients have a higher likelihood to die even if they survive their injury in the hospital compared to non-trauma patients," according to Dr. Arbabi. 

The study appears in this week's Journal of the American Medical Association

After hospitalization for trauma, about half the patients go home, the rest are admitted to rehabilitation or skilled nursing facilities.  "Patients that get discharged to skilled nursing facilities as opposed to patients that get discharged to rehab centers or patients that get discharged home have higher risk of death in one year and three years," according to Arbabi.  Researchers do emphasize that patients released to skilled nursing facilities are often older and lower functioning than those who go elsewhere. "It doesn't suggest that skilled nursing facility is the cause, it's an association but it does suggest that there is an area that we can improve outcomes," Arbabi points out.

Researchers say the next step would be compiling outcome data from skilled nursing facilities like hospitals provide to look at ways of increasing survival rates at those facilities.

Copyright 2011 ABC News Radio

ABC News Radio