Pediatric Transport-Specific Illness Severity Scores Predict Clinical Deterioration of Transported Patients.

OBJECTIVE: The Transport Risk Assessment in Pediatrics (TRAP) and Transport Pediatric Early Warning Scores (T-PEWS) are transport-specific pediatric illness severity scores that are adjunct assessment tools for determining disposition of transported patients. We hypothesized that these scores would predict the risk of clinical deterioration in transported patients admitted to general pediatric wards. METHODS: Activation of a rapid response team (RRT) in the first 24 hours of admission was used as a marker of deterioration. All pediatric transports between March 2017 and February 2020 admitted via critical care transport were included. Transports to the emergency department (ED) were excluded. This retrospective chart review evaluated TRAP and T-PEWS scores at 3 points: (1) arrival of transport team at referring hospital, (2) admission to the children's hospital, and (3) RRT activation, if occurring within 24 hours of admission. RESULTS: There were 1137 team transports during this period. Three hundred ninety-nine patients transported to the ED were excluded, leaving 738 included patients; 405 (55%) admitted to the general wards and 333 (45%) admitted to the pediatric intensive care unit. Twenty-five patients admitted to the wards (6%) had an RRT activation within 24 hours of admission. Statistical analysis used 2-sample t tests. There was a statistically significant difference in scores for ward admissions between those who had RRT activation and those who did not. CONCLUSIONS: Both TRAP and T-PEWS can be used to predict the risk of clinical deterioration in transported patients admitted to general wards. These scores may assist in assessing which patients admitted to the wards need closer observation.

The Potential Impact of Food Insecurity in an Urban Trauma Population.

BACKGROUND: Food insecurity (FI) has been defined as a lack of consistent access to enough food for a healthy active lifestyle. As of 12.7% of the United States are suffering from FI, which has been correlated with increased hospital costs and poorer health outcomes. Currently, limited data exists examining the relationship between trauma populations and FI despite both having similar root causes. We sought to determine this and validate a screening tool for FI in this population. METHODS: A cross-sectional survey study of trauma patients was conducted at a level 1 trauma center in Atlanta, Georgia. Survey questions included the first two items of the Core Food Security Module. Zip codes were used to determine FI, defined by the USDA Food Access Research and compared to individual participant survey responses. Binary classification test metrics were calculated to validate the two items as a screening tool in this population. RESULTS: The cohort included 136 patients, of which the majority were black (60.3%) and male (60.3%). Thirty-one respondents affirmed food security (22.8%) despite over half (51.5%) living in a food insecure community. The sensitivity and specificity for this screening to predict FI were 25 and 80%, respectively. CONCLUSION: Although the specificity is high, this screening tool has a low sensitivity, accuracy, NPV, and PPV to determine food insecurity in this population. Community-level statistics suggests that food insecurity is a significant public problem amongst trauma patients. Prevention efforts should, therefore, aim to address both issues simultaneously.

Second Victim Syndrome in Trauma Practitioners and Other Ancillary Staff.

In health care, second victims are traumatized clinicians involved in unanticipated or untoward patient events. Programs that address second victim syndrome are sparse and its diagnosis often goes unrecognized. Consistently, literature has identified gaps in support resources, leading to compromised patient care and provider health. This project evaluates the need for second victim resources in trauma care providers at a tertiary public level 1 trauma hospital by electronically implementing a validated second victim survey over 5 weeks. Our results illustrate that second victim syndrome is prevalent among 57.1% of trauma care providers, of which 22.9% agree that second victim syndrome results in some form of undesirable work intentions.

Screening, Brief Intervention, and Referral to Treatment to Prevent Post-Traumatic Stress Disorder After Gunshot Wounds.

Screening, brief intervention, and referral to treatment (SBIRT) is an intervention originally developed to prevent and deter substance abuse. Adaptation of the SBIRT model to prevent post-traumatic stress disorder (PTSD) may potentially reduce acute stress symptoms after traumatic injury. We conducted a prospective randomized control study of adult patients admitted for gunshot wounds. Patients were randomized to intervention (INT) vs. treatment as usual (TAU) groups. INT received the newly developed SBIRT Intervention for Trauma Patients (SITP)-a 15-minute session with elements of cognitive behavioral therapy techniques. SITP took place during the index hospitalization; both groups had followup at 30 and 90 days at which time a validated PTSD screening tool, PCL-5, was administered. Most of the 46 participants were young (mean age = 30.5y), male (91.3%), and black (86.9%). At three-month follow-up, SBIRT and TAU patients had similar physical healing scores but the SBIRT arm showed reductions in PTSD symptoms.

Event boundaries and anaphoric reference.

The current study explored the finding that parsing a narrative into separate events impairs anaphor resolution. According to the Event Horizon Model, when a narrative event boundary is encountered, a new event model is created. Information associated with the prior event model is removed from working memory. So long as the event model containing the anaphor referent is currently being processed, this information should still be available when there is no narrative event boundary, even if reading has been disrupted by a working-memory-clearing distractor task. In those cases, readers may reactivate their prior event model, and anaphor resolution would not be affected. Alternatively, comprehension may not be as event oriented as this account suggests. Instead, any disruption of the contents of working memory during comprehension, event related or not, may be sufficient to disrupt anaphor resolution. In this case, reading comprehension would be more strongly guided by other, more basic language processing mechanisms and the event structure of the described events would play a more minor role. In the current experiments, participants were given stories to read in which we included, between the anaphor and its referent, either the presence of a narrative event boundary (Experiment 1) or a narrative event boundary along with a working-memory-clearing distractor task (Experiment 2). The results showed that anaphor resolution was affected by narrative event boundaries but not by a working-memory-clearing distractor task. This is interpreted as being consistent with the Event Horizon Model of event cognition.

Event boundaries and memory improvement.

The structure of events can influence later memory for information that is embedded in them, with evidence indicating that event boundaries can both impair and enhance memory. The current study explored whether the presence of event boundaries during encoding can structure information to improve memory. In Experiment 1, memory for a list of words was tested in which event structure was manipulated by having participants walk through a doorway, or not, halfway through the word list. In Experiment 2, memory for lists of words was tested in which event structure was manipulated using computer windows. Finally, in Experiments 3 and 4, event structure was manipulated by having event shifts described in narrative texts. The consistent finding across all of these methods and materials was that memory was better when the information was distributed across two events rather than combined into a single event. Moreover, Experiment 4 demonstrated that increasing the number of event boundaries from one to two increased the memory benefit. These results are interpreted in the context of the Event Horizon Model of event cognition.