Browsing by Subject "Trauma"

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  • Puolakkainen, Tero; Toivari, Miika; Puolakka, Tuukka; Snäll, Johanna (2022)
    Background Numerous guidelines highlight the need for early airway management in facial trauma patients since specific fracture patterns may induce airway obstruction. However, the incidence of these hallmark injuries, including flail mandibles and posterior displacement of the maxilla, is contentious. We aim to evaluate specific trauma-related variables in facial fracture patients, which affect the need for on-scene versus in-hospital airway management. Methods This retrospective cohort study included all patients with any type of facial fracture, who required early airway management on-scene or in-hospital. The primary outcome variable was the site of airway management (on-scene versus hospital) and the main predictor variable was the presence of a traumatic brain injury (TBI). The association of fracture type, mechanism, and method for early airway management are also reported. Altogether 171 patients fulfilled the inclusion criteria. Results Of the 171 patients included in the analysis, 100 (58.5) had combined midfacial fractures or combination fractures of facial thirds. Altogether 118 patients (69.0%) required airway management on-scene and for the remaining 53 patients (31.0%) airway was secured in-hospital. A total of 168 (98.2%) underwent endotracheal intubation, whereas three patients (1.8%) received surgical airway management. TBIs occurred in 138 patients (80.7%), but presence of TBI did not affect the site of airway management. Younger age, Glasgow Coma Scale-score of eight or less, and oro-naso-pharyngeal haemorrhage predicted airway management on-scene, whereas patients who had fallen at ground level and in patients with facial fractures but no associated injuries, the airway was significantly more often managed in-hospital. Conclusions Proper preparedness for airway management in facial fracture patients is crucial both on-scene and in-hospital. Facial fracture patients need proper evaluation of airway management even when TBI is not present.
  • Suomalainen, L.; Haravuori, H.; Berg, N.; Kiviruusu, O.; Marttunen, M. (2011)
    Background: In November 2007, a student shot eight people and himself at Jokela High School, Finland. This study aims to evaluate the long-term effects of exposure to a school shooting among adolescents. Method: Associations between psychological outcomes and background factors were analysed and compared with "comparison students" four months after the incident. A questionnaire including Impact of Event Scale (IES) and General Health Questionnaire (GHQ-36) was used. Results: Half of the females and a third of the males suffered from posttraumatic distress. High level of posttraumatic distress (IES >= 35), predicting PTSD, was observed in 27% of the females and 7% of the males. The odds ratio was 6.4 (95% confidence interval 3.5-10.5) for having high levels of posttraumatic distress. Severe or extreme exposure and female gender were found to increase the risk. Forty-two percent of the females and 16% of the males had psychiatric disturbance (GHQ >= 9). Severe or extreme exposure, older age and female gender increased the risk. Perceived support from family and friends was found to be protective. Conclusions: The observed risk and protective factors were similar to earlier studies. Follow-up will be essential in identifying factors predicting persisting trauma-related symptoms in adolescence. (C) 2010 Elsevier Masson SAS. All rights reserved.
  • Kangaslampi, Samuli; Garoff, Ferdinand; Golden, Shannon; Peltonen, Kirsi (2021)
    We analyzed the network structure of DSM-IV PTSD symptoms among 2792 help-seeking Central and East African refugees in Kenya exposed to multiple, severe traumatic events and on-going stressors. To some extent, our results reproduced structures identified among clinical populations in Europe, including strong links within traditional symptom clusters, such as between avoidance of thoughts and situations, and hypervigilance and startling. However, we found substantial differences in most central symptoms, with detachment and disinterest far less and emotional numbing and concentration problems more central in our analyses. Our networks did not reproduce the common finding of particularly low centrality of amnesia. We further noted substantive similarities in network structure, but also differences, between refugees living in an urban environment and in refugee camps. Concentration problems were most central among mainly Somali refugees at a refugee camp, and associated with amnesia and sense of foreshortened future, while emotional numbing was the most central symptom among majority Congolese refugees in Nairobi. Our findings highlight the importance of contextual and cultural factors for PTSD symptomatology, and are informative for assessment and treatment among help-seeking refugees.
  • Bensch, Frank; Varjonen, Elina A.; Pyhältö, Tuomo T.; Koskinen, Seppo K. (2019)
    Purpose BCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke. Methods Denver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma. Results 1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke (p <.0001; OR = 9.77; 95% CI 3.3-28.7). Eleven percent of patients with BCVI would not have met standard screening criteria. Conclusions The increase in detection rate for BCVI justifies more liberal screening protocols.
  • Irfan, Furqan B.; Consunji, Rafael; El-Menyar, Ayman; George, Pooja; Peralta, Ruben; Al-Thani, Hassan; Thomas, Stephen Hodges; Alinier, Guillaume; Shuaib, Ashfaq; Al-Suwaidi, Jassim; Singh, Rajvir; Castren, Maaret; Cameron, Peter A.; Djarv, Therese (2017)
    Background: Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. Methods: An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). Results: A total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood transfusion, and surgery were associated with higher odds of survival. Adrenaline (Epinephrine) lowered the odds of survival. Conclusion: The incidence of OHTCA was less than expected, with a low rate of survival. Thoracotomy was not associated with improved survival while Adrenaline administration lowered survival in OHTCA patients with majority blunt injuries. Interventions to enable early prehospital control of hemorrhage, blood transfusion, thoracostomy and surgery improved survival. (C) 2017 Elsevier B.V. All rights reserved.
  • Puolakkainen, T; Thoren, H; Vahasilta, L; Narjus-Sterba, M; Wilson, ML; Brinck, T; Snall, J (2021)
    Evidence supports the notion that craniofacial fractures are significant predictors of cervical spine injuries (CSIs), but some debate remains on the injury mechanism of co-existing CSIs in craniofacial fractures and the relationship between CSI and specific facial fractures. In this retrospective study, we aim to assess the incidence rates of specific facial fracture types as well as other important variables and their relationship with CSIs. The primary outcome variable, CSI, and several predictor variables, including facial fracture type, were evaluated with logistic regression analyses. Of 2919 patients, the total CSI incidence rate was 3.0%. Rates of CSI in patients with isolated mandibular fractures (OR 0.26 CI 0.10, 0.63; p = 0.006) were lower than those previously reported, whereas isolated nasal fractures were strongly associated with CSI (OR 2.67 CI 1.36, 5.22; p = 0.004). Patients with concomitant cranial injuries were twice as likely to have CSI (OR 2.00, CI 1.22, 3.27; p = 0.006). Even though there is a strong occurrence rate of CSIs in patients with cranial injuries, clinicians should be aware that patients presenting with isolated facial fractures are at significant risk for sustaining CSIs also. (C) 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
  • Irfan, Furqan B.; Consunji, Rafael I. G. D. J.; Peralta, Ruben; El-Menyar, Ayman; Dsouza, Landric B.; Al-Suwaidi, Jassim M.; Singh, Rajvir; Castren, Maaret; Djarv, Therese; Alinier, Guillaume (2022)
    Background Cardiac arrests in admitted hospital patients with trauma have not been described in the literature. We defined "in-hospital cardiac arrest of a trauma" (IHCAT) patient as "cessation of circulatory activity in a trauma patient confirmed by the absence of signs of circulation or abnormal cardiac arrest rhythm inside a hospital setting, which was not cardiac re-arrest." This study aimed to compare epidemiology, clinical presentation, and outcomes between in- and out-of-hospital arrest resuscitations in trauma patients in Qatar. It was conducted as a retrospective cohort study including IHCAT and out-of-hospital trauma cardiac arrest (OHTCA) patients from January 2010 to December 2015 utilizing data from the national trauma registry, the out-of-hospital cardiac arrest registry, and the national ambulance service database. Results There were 716 traumatic cardiac arrest patients in Qatar from 2010 to 2015. A total of 410 OHTCA and 199 IHCAT patients were included for analysis. The mean annual crude incidence of IHCAT was 2.0 per 100,000 population compared to 4.0 per 100,000 population for OHTCA. The univariate comparative analysis between IHCAT and OHTCA patients showed a significant difference between ethnicities (p=0.04). With the exception of head injury, IHCAT had a significantly higher proportion of localization of injuries to anatomical regions compared to OHTCA; spinal injury (OR 3.5, 95% CI 1.5-8.3, p
  • Erkman, Ahmet Cem; Basoglu, Oksan; Basibuyuk, Gulusan Ozgun; Kirmizioglu, Pinar Gozluk; Yigit, Ayhan; Yalcin, Yarenkur Alkan; Kaya, Ferhat (2016)
    The excavations conducted at Van Castle Mound, East Anatolia, between 1987 and 2010 uncovered a total of 328 human skeletons dating back to the Medieval period. Thirty trauma cases were identified within the collection, constituting 9.14% of the entire population. Typology and distribution of the trauma among different sexes indicated that depression fractures, oblique fractures, comminuted fractures, and head deformation were more frequently observed in male skeletons, while a post-fractural infection appeared only in a female skeleton. Trauma cases were more common on post-cranial bones. In addition, a trepanned cranial specimen belonging to a mature individual is identified in which grooving technique was performed. Most of the observed trauma cases were related to heavy labor, unsafe working conditions, and challenges of everyday agrarian life. Previous paleopathological studies from the Medieval Van Castle Mound also indicates an insufficient nutritation and high physical stress.
  • Wahlin, Rebecka Rubenson; Ponzer, Sari; Skrifvars, Markus B.; Lossius, Hans Morten; Castren, Maaret (2016)
    Background: Trauma systems and regionalized trauma care have been shown to improve outcome in severely injured trauma patients. The aim of this study was to evaluate the implementation of a prehospital trauma care protocol and transport directive, and to determine its effects on the number of primary admissions and secondary trauma transfers in a large Scandinavian city. Methods: We performed a retrospective observational study based on local trauma registries and hospital and ambulance records in Stockholm County; patients > 15 years of age with an Injury Severity Score (ISS) > 15 transported to any emergency care hospitals in the Stockholm area were included for the years 2006 and 2008. We also included secondary transferred patients to the regional trauma center during 2006, 2008, and 2013. Results: A total of 693 primarily admitted trauma patients were included for the years 2006 and 2008. For the years 2006, 2008 and 2013, we included 114 secondarily transported trauma patients. The number of primary patient transports to the trauma center increased during the years by 20.2 %, (p <0.001); patients primarily transported to the trauma center had a significantly higher Injury Severity Score in 2008 than in 2006, and the number of patients transported secondarily to the trauma center in 2006 was higher compared to 2008 and to 2013 (p <0.001, all 3 years). Discussion: Our data indicate that implementation of a prehospital trauma care protocol may have an effect on transportation of severely injured trauma patients. A decrease in secondarily transported trauma patients to the regional trauma center was noted after 1 year and persisted at 7 years after the organizational change. Patients primarily admitted to the trauma center after the change had more severe injuries than patients transported to other emergency hospitals in the area even if 20 % of patients were not admitted primarily to a trauma center. This does not imply that the transport directives or the criteria were not followed but rather reveals the difficulties and uncertainties of field triage. Conclusions: With the introduction of a prehospital trauma transport directive in a large urban city, an increase in patients transported to the regional trauma center and a decrease in secondary transfers were detected, but a considerable number of severely injured patients were still transported to local hospitals.
  • Podda, Mauro; De Simone, Belinda; Ceresoli, Marco; Virdis, Francesco; Favi, Francesco; Larsen, Johannes Wiik; Coccolini, Federico; Sartelli, Massimo; Pararas, Nikolaos; Beka, Solomon Gurmu; Bonavina, Luigi; Bova, Raffaele; Pisanu, Adolfo; Abu-Zidan, Fikri; Balogh, Zsolt; Chiara, Osvaldo; Wani, Imtiaz; Stahel, Philip; Di Saverio, Salomone; Scalea, Thomas; Soreide, Kjetil; Sakakushev, Boris; Amico, Francesco; Martino, Costanza; Hecker, Andreas; De'Angelis, Nicola; Chirica, Mircea; Galante, Joseph; Kirkpatrick, Andrew; Pikoulis, Emmanouil; Kluger, Yoram; Bensard, Denis; Ansaloni, Luca; Fraga, Gustavo; Civil, Ian; Tebala, Giovanni Domenico; Di Carlo, Isidoro; Cui, Yunfeng; Coimbra, Raul; Agnoletti, Vanni; Sall, Ibrahima; Tan, Edward; Picetti, Edoardo; Litvin, Andrey; Damaskos, Dimitrios; Inaba, Kenji; Leung, Jeffrey; Maier, Ronald; Biffl, Walt; Leppaniemi, Ari; Moore, Ernest; Gurusamy, Kurinchi; Catena, Fausto (2022)
    Background In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. Methods Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM. Results Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate >= 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I-II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II-III, AAST Grades III-V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries-WSES Class I, AAST Grades I-II) to 3 days (for high-grade splenic injuries-WSES Classes II-III, AAST Grades III-V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48-72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV-V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48-72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications. Conclusion This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.
  • Kangaspuro, Markku Veli; Lassila, Jussi Pekka (Palgrave Macmillan, 2017)
  • 2019 World Society of Emergency Surgery (WSES) Nijmegen splenic injury collaboration group; Amico, Francesco; Anning, Rebecca; Bendinelli, Cino; Balogh, Zsolt J.; Leppäniemi, Ari; Tolonen, Matti I A (2020)
    Background Recent trauma guidelines recommend non-operative management for grade III splenic injury without contrast extravasation on computed tomography. Nevertheless, such recommendations rely on low-quality evidence, and practice variation characterizes clinical management for this type of injury. We aimed to identify the role of eleven selected clinical factors influencing the management of grade III splenic injury without contrast extravasation by expert consensus and a modified Delphi approach. Methods A questionnaire was developed with the endorsement of the World Society of Emergency Surgery (WSES). This was delivered and answered live by acute care surgeons attending the 6(th)WSES congress in Nijmegen in 2019. A dedicated mobile phone application was utilized to collect the answers. All answers were evaluated for areas of discrepancy with an 80% threshold for consensus between respondents. Results Three factors generated discrepancy in opinion for managing this pattern of injury: the patients' injury severity, the presence of a bleeding diathesis, and an associated intra-abdominal injury. Agreement was obtained for the other eight factors. Conclusion Researchers should focus their efforts on the identified area of discrepancy. Clinicians should use additional care in the presence of the three factors for which discordant opinions were found.
  • Yliharju, Heidi; Jama, Timo; Nordquist, Hilla (2022)
    Background Treating hemorrhaging patients with prehospital blood product transfusions (PHBT) narrows transfusion delays and potentially benefits the patient. We describe our initial experiences of PHBT in a ground-based emergency medical service (EMS), where the transfusion protocol covers both traumatic and nontraumatic hemorrhaging patients. Methods A descriptive retrospective analysis was performed on the records of all the patients receiving red blood cells, freeze-dried plasma, or both during prehospital care from September 2016 to December 2020. The delays of PHBT and the effects on patients' vital signs were analyzed and reported as the median and interquartile range (IQR) and analyzed using a Wilcoxon Signed rank test. Results 65 patients received prehospital blood product transfusions (PHBT), 29 (45%) were non-traumatic, and 36 (55%) traumatic. The main two reasons for PHBT were blunt trauma (n = 30, 46%) and gastrointestinal hemorrhage (n = 20, 31%). The median time from the emergency call to the start of PHBT was 54 min (IQR 38), and the transfusion began on a median of 61 min (IQR 42) before arrival at the hospital. The median systolic blood pressure improved from a median 76.5 mmHg (IQR 36.5) before transfusion to a median of 116.60 mmHg (IQR 26.5) (p < 0.001) on arrival to the hospital. No transfusion-related severe adverse events were noted. Conclusions Starting PHBT in ground-based EMS is a feasible and viable option. The PHBT began significantly earlier than it would have started on arrival to the hospital, and it seems to be safe and improve patients' physiology. Study approval D/2603/07.01.04.05/2019.
  • Bister, Ville; Lenkkeri, Timo; Parkkinen, Markus; Lindahl, Jan (2022)
    Background and purpose: Intra-articular distal tibial fractures are most commonly caused by high-energy trauma. Additional difficulties are related to accompanying soft-tissue injuries. The purpose of this study was to evaluate the consequences of different types of distal tibial fractures to the individual patient and to the public health care system.Patients and methods: 126 patients with operatively treated intra-articular distal tibial fracture were iden-tified between 2012 and 2016. Thirty-one (25%) were open fractures. Acute treatment, timing of definitive surgery, total number of surgical procedures, complications, need for soft-tissue reconstructions, hospital stay, and number of follow-up visits were recorded related to AO/OTA fracture types.Results: 112 patients (89%) were treated with a staged treatment protocol. Of these patients, 74 first received an external fixation device. The definitive fracture fixation was performed on average 8 days after the trauma. Soft-tissue flap reconstruction was needed in 19 patients (15%). Additionally, 7 patients required split-thickness skin grafting. Total hospital stay ranged from 2 to 87 days (median 14 days). The median ward treatment period was 12 days in B2-3 group, 13 days in C1-2 group, and 18 days in C3 group. The median of 2 (range 1-13) surgical procedures were performed. Interpretation: Intra-articular distal tibial fractures cause a major burden to individual patients and stresses the public health care system due to a frequent need for several surgical procedures because of soft-tissue injuries and complications. AO/OTA type C3 fractures had the greatest burden, as patients required several consecutive operations and prolonged hospital stays.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )
  • Coccolini, Federico; Catena, Fausto; Montori, Giulia; Ceresoli, Marco; Manfredi, Roberto; Nita, Gabriela Elisa; Moore, Ernest E.; Biffl, Walter; Ivatury, Rao; Whelan, James; Fraga, Gustavo; Leppaniemi, Ari; Sartelli, Massimo; Di Saverio, Salomone; Ansaloni, Luca (2015)
    Actually the most common indications for Open Abdomen (OA) are trauma, abdominal sepsis, severe acute pancreatitis and more in general all those situations in which an intra-abdominal hypertension condition is present, in order to prevent the development of an abdominal compartment syndrome. The mortality and morbidity rate in patients undergone to OA procedures is still high. At present many studies have been published about the OA management and the progresses in survival rate of critically ill trauma and septic surgical patients. However several issues are still unclear and need more extensive studies. The definitions of indications, applications and methods to close the OA are still matter of debate. To overcome this lack of high level of evidence data about the OA indications, management, definitive closure and follow-up, the World Society of Emergency Surgery (WSES) promoted the International Register of Open Abdomen (IROA). The register will be held on a web platform (Clinical Registers (R)) through a dedicated web site: www. clinicalregisters. org. This will allow to all surgeons and physicians to participate from all around the world only by having a computer and a web connection. The IROA protocol has been approved by the coordinating center Ethical Committee (Papa Giovanni XXIII hospital, Bergamo, Italy).
  • Laaksonen, Sauli; Jokelainen, Pikka; Pusenius, Jyrki; Oksanen, Antti (2017)
    Background: Slaughter reindeer are exposed to stress caused by gathering, handling, loading and unloading, and by conditions in vehicles during transport. These stress factors can lead to compromised welfare and trauma such as bruises or fractures, aspiration of rumen content, and abnormal odour in carcasses, and causing condemnations in meat inspection and lower meat quality. We investigated the statistical association of slaughter transport distance with these indices using meat inspection data from years 2004-2016, including inspection of 669,738 reindeer originating from Finnish reindeer herding areas. Results: Increased stress and decreased welfare of reindeer, as indicated by higher incidence of carcass condemnation due to bruises or fractures, aspiration of rumen content, or abnormal odour, were positively associated with systems involving shorter transport distances to abattoirs. Significant differences in incidence of condemnations were also detected between abattoirs and reindeer herding cooperatives. Conclusions: This study indicates that in particular the short-distance transports of reindeer merit more attention. While the results suggest that factors associated with long distance transport, such as driver education, truck design, veterinary supervision, and specialist equipment, may be favourable to reducing pre-slaughter stress in reindeer when compared with short distance transport systems, which occur in a variety of vehicle types and may be done by untrained handlers. Further work is required to elucidate the causal factors to the current results.
  • Laaksonen, Sauli; Jokelainen, Pikka; Pusenius, Jyrki; Oksanen, Antti (BioMed Central, 2017)
    Abstract Background Slaughter reindeer are exposed to stress caused by gathering, handling, loading and unloading, and by conditions in vehicles during transport. These stress factors can lead to compromised welfare and trauma such as bruises or fractures, aspiration of rumen content, and abnormal odour in carcasses, and causing condemnations in meat inspection and lower meat quality. We investigated the statistical association of slaughter transport distance with these indices using meat inspection data from years 2004–2016, including inspection of 669,738 reindeer originating from Finnish reindeer herding areas. Results Increased stress and decreased welfare of reindeer, as indicated by higher incidence of carcass condemnation due to bruises or fractures, aspiration of rumen content, or abnormal odour, were positively associated with systems involving shorter transport distances to abattoirs. Significant differences in incidence of condemnations were also detected between abattoirs and reindeer herding cooperatives. Conclusions This study indicates that in particular the short-distance transports of reindeer merit more attention. While the results suggest that factors associated with long distance transport, such as driver education, truck design, veterinary supervision, and specialist equipment, may be favourable to reducing pre-slaughter stress in reindeer when compared with short distance transport systems, which occur in a variety of vehicle types and may be done by untrained handlers. Further work is required to elucidate the causal factors to the current results.
  • WSES-AAST Expert Panel; Coccolini, Federico; Moore, Ernest E.; Kluger, Yoram; Leppäniemi, Ari; Catena, Fausto (2019)
    Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.
  • Meling, Emilia (Helsingin yliopisto, 2020)
    The objective of this study is to highlight traumas experienced by a student and to examine how the traumas arise in school context. I also examine what kind of support school was able to provide for the traumatized student. Purpose of this study is to provide knowledge and possible means for caretakers to encounter a traumatized child. In this study the voice is given to a young person who has been struggling with traumas during her time in school and her narrative is used to determine the student’s personal experiences of reconciling the traumas and school. The person who participated in this study was a former youth in a youth detention centre, whose traumas passed throughout her whole school time, especially throughout the secondary school and beginning of high school, which are the main subjects of this study. Purpose of this study is not to generalize, but to bring out this youth’s valuable story to the public by collecting relevant data. The study is a qualitative case study and collected material is used to highlight information about the factors that led to the traumas and in particular, what kind of support was available at school and what kind of support would have been needed. Data collection methods were observation, daily reports and open interviews. Analysis of the collected material was carried out according to methods of content analysis. Study results showed that traumas had significant links to a child’s well-being, learning and need for support at school. Trauma was caused by attachment problems and lack of basic needs of the child. My study is partly related to the attachment theory. Based on this, the early age problems of interaction seemed to affect later social life, psyche and coping with school. Problems reflected to school as social challenges and caused learning, concentration and behavioral problems. Hiding behind defenses, loneliness and labelled difference led to a decline in school motivation and performance. Support provided was not sufficient and all parties; teachers, classmates and the youth herself were exhausted. Traumas appear in school context in many ways in all areas of studying. In school context, there does not always seem to be enough time, means, skills or resources to face children who are severely traumatized and therefore mentally unstable.
  • Eränen, Liina Sofia Eleonoora (Helsingin yliopisto, 2021)
    Tutkielmassa tarkastellaan vuonna 1994 uponneen M/S Estonian pelastustöihin osallistuneiden autolauttojen henkilökunnan traumaperäisen stressin oireita (PTSD). Tutkielman tavoitteena on selvittää millainen yhteys trauman aikana koetulla pelolla, trauma-altistuksella sekä psykologiseen debriefing-tilaisuuteen osallistumisella on suuronnettomuuden aiheuttamien PTSD-oireiden voimakkuuteen. Teoriataustana hyödynnetään Janoff-Bulmanin perususkomusten teoriaa, jonka mukaan traumaattisia kokemuksia kohdanneiden yksilöiden voi olla haastava sisällyttää traumakokemuksiaan maailmankuvaansa, mikä johtaa tiedonkäsittelylle keskeisten perususkomusten pirstaloitumiseen. Teorian mukaan traumaattisille kokemuksille on tyypillistä, että yksilö joutuu kohtaamaan haavoittuvuutensa sekä ympäristönsä epäoikeudenmukaisuuden. Aineistona toimii vuonna 1995 poikkileikkausaineistona kerätty survey-kysely, johon ovat vastanneet Merimies Unionin jäsenet (N = 636), jotka työskentelivät pelastustöihin osallistuneilla autolautoilla onnettomuuden aikoihin. Tutkielmassa keskitytään tarkastelemaan onnettomuusyönä työvuorossa olleita henkilökunnan jäseniä (N = 261). Analyysimenetelminä käytettiin muun muassa eksploratiivista faktorianalyysia, Pearsonin korrelaatiokertoimia sekä usean muuttujan lineaarista regressioanalyysia, joilla selvitettiin tutkielmalle asetettuja hypoteeseja. Lisäanalyyseina hyödynnettiin moderaatioanalyysia sekä yksisuuntaista varianssianalyysia. Tulosten mukaan koettu pelko on tilastollisesti erittäin merkitsevästi yhteydessä PTSD-oireiden voimakkuuteen, oletusten mukaisesti. Onnettomuuden aikaisille järkyttäville tapahtumille altistumisen havaitaan olevan negatiivisessa yhteydessä koettujen PTSD-oireiden voimakkuuteen tilastollisesti jokseenkin merkitsevästi, mikä on ristiriidassa lähtöoletusten kanssa. Debriefing-tilaisuuteen osallistumisen havaitaan olevan tilastollisesti merkitsevästi positiivisessa yhteydessä koettujen PTSD-oireiden voimakkuuteen, mikä on niin ikään lähtöoletusten vastaista. Jatkotarkasteluissa havaittiin trauma-altistuksen ja debriefingiin osallistumisen moderoivan PTSD-oireiden voimakkuutta tilastollisesti merkitsevästi. Interaktiotermin visuaalisissa tarkasteluissa altistumattomilla ja debriefingiin osallistuneilla vastaajilla havaittiin olevan tilastollisesti merkitsevästi voimakkaampia PTSD-oireita verrattuna muihin vastaajiin. Altistuneiden joukossa PTSD-oireiden voimakkuus on keskiarvoisesti yhtä suurta, riippumatta siitä onko vastaaja osallistunut debriefingiin. Keskiarvoisesti vähiten oireita havaitaan altistumattomilla ja debriefingiin osallistumattomilla vastaajilla. Tutkielman tulokset tukevat aiemman tutkimuksen havaintoja trauman aikaisen pelon vaikutuksista uhrien PTSD-oireiden voimakkuuteen. Tulokset antavat lisäksi viitteitä siitä, ettei trauma-altistuksen ja PTSD-oireiden voimakkuuden yhteyttä voida pitää niin yksiselitteisenä kuin aiempi kirjallisuus on joskus olettanut. Jatkossa tulisi tarkastella laajemmin voiko yksilön toiminta, kuten muiden uhrien auttaminen trauman aikana muodostua oireilta suojaavaksi tekijäksi.Tutkielman tulosten sekä aiempien tutkimusten perusteella debriefingin käyttöä tulee tarkastella kriittisesti. Aiemmassa tutkimuksessa on harvemmin tarkasteltu trauma-altistuksen sekä debriefingin interaktioiden vaikutusta PTSD-oireiden voimakkuuteen. Tutkielman tulokset viittaavat kuitenkin siihen, että debriefing saattaa vaikuttaa eri tavoin eri trauma-altistuksen kohdanneiden uhrien toipumiseen. Tulosten perusteella keskiarvoisesti voimakkaimmista oireista kärsivät vähiten altistuneet sekä debriefingiin osallistuneet vastaajat. Traumoista toipumisen näkökulmasta olisi jatkossa tärkeää selvittää kenelle debriefingiin osallistuminen on hyödyllistä ja kenelle se saattaa olla haitallista.