Signs of trauma
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Signs of Trauma: A Comprehensive Overview
Ocular Signs in Pediatric Abusive Head Trauma
Intraocular Hemorrhages (IOH)
In pediatric abusive head trauma (AHT), intraocular hemorrhages (IOH) are a significant diagnostic marker. Studies show that IOH, especially when bilateral, extensive, and multilayered, have a high specificity (94%) for AHT, making them a critical sign to look for in suspected cases 1.
Optic Nerve Sheath Hemorrhages
Optic nerve sheath hemorrhages are also more common in AHT compared to other conditions, with a sensitivity and specificity of 72% and 71%, respectively 1.
Traumatic Retinoschisis and Perimacular Retinal Folds
Although less common, traumatic retinoschisis and perimacular retinal folds are present in a minority of AHT cases (8% and 14%, respectively) but are rarely seen in other conditions, further aiding in the diagnosis 1.
External Signs of Trauma in Falls
Ground Level Falls and Found Down Incidents
External signs of trauma (EST) and symptoms (SS) following ground level falls or found down incidents are not reliable predictors of significant injury. The diagnostic accuracy of EST for significant findings (SF) and Injury Severity Score (ISS) > 8 is low, with positive and negative likelihood ratios indicating poor predictive value 2.
Lack of Symptoms
However, the absence of symptoms (SS) can be reasonably accurate in ruling out significant findings, though it is less effective for ruling out severe injuries (ISS > 8) 2.
Psychological Signs of Trauma
Post-Traumatic Stress Symptoms (PTSS)
Different traumatic events can lead to varying manifestations of post-traumatic stress symptoms (PTSS). Sexual trauma, for instance, is associated with higher levels of PTSS compared to motor vehicle accidents or sudden loss. Common symptoms across various traumas include psychological cue reactivity, avoidance, and difficulties with sleeping and concentrating 4.
Trauma Symptom Inventory (TSI)
The Trauma Symptom Inventory (TSI) is a widely used tool to assess a range of trauma-related symptoms, including those from sexual and physical assault, spousal abuse, and major accidents. It helps in identifying complex presentations that may include dissociation, identity disturbance, and self-injury 5.
Traumatic Brain Injury (TBI)
Subtle Signs and Delayed Symptoms
Traumatic brain injuries (TBI) can present subtle signs that may not appear until days or weeks after the injury. Symptoms can include changes in behavior, mood, and cognitive function, making it crucial for caregivers to monitor individuals closely following a head injury 6.
Early Psychological Distress in Trauma Survivors
Communication with Healthcare Professionals
Early signs of psychological distress in trauma survivors can be identified through their communications with healthcare professionals. Themes such as pain, powerlessness, and self-blame are common and can indicate future mental health issues, highlighting the need for attentive care and early intervention 7.
Conclusion
Understanding the various signs of trauma, from ocular indicators in pediatric abusive head trauma to the psychological symptoms following different traumatic events, is crucial for accurate diagnosis and effective intervention. While some signs, like intraocular hemorrhages, are highly specific, others, such as external signs following falls, are less reliable. Early identification and appropriate response to these signs can significantly impact the treatment and recovery of trauma survivors.
Sources and full results
Most relevant research papers on this topic
A systematic review of the diagnostic accuracy of ocular signs in pediatric abusive head trauma.
Intraocular hemorrhages in infants are highly specific for pediatric abusive head trauma, with optic nerve sheath hemorrhages being more common than other conditions.
Systematic Review
Highly CitedExternal signs of trauma: A poor predictor of injury in found down and ground level falls.
External signs of trauma (EST) are insufficiently accurate to predict injury severity in ground level falls or found down patients, and triage using EST alone is not useful.
Observational StudyPathology of trauma.
Trauma to the central nervous system can cause hemorrhage, contusions, and tears, affecting the brain and spinal cord.
Highly CitedDo different traumatic events invoke different kinds of post-traumatic stress symptoms?
Post-traumatic stress symptoms vary in severity and profiles depending on the type of trauma exposure, which may impact treatment responsiveness.
Very Rigorous JournalTrauma Symptom Inventory
The Trauma Symptom Inventory (TSI) is a widely used self-report measure for assessing trauma-related symptoms in adults, covering a wide range of impacts.
Highly CitedTraumatic Brain Injury: Signs and Symptoms
TBI symptoms may be subtle and may not appear for days or weeks after the injury.
Interviews following physical trauma: A thematic analysis.
Trauma survivors share key themes with medical professionals, which can help identify early signs of psychological distress and support their mental health.
Observational StudyThe Illness of Trauma.
Traumatic shock is primarily due to fat embolism, with increased capillary permeability and hypoxia leading to fluid loss and sludging.
The effect of trauma on the severity of obsessive-compulsive spectrum symptoms: A meta-analysis.
Exposure to past trauma is associated with a higher severity of obsessive-compulsive spectrum symptoms, with a stronger association for females and four types of interpersonal trauma.
Meta-Analysis
Rigorous Journal