Sex differences in the severity and natural recovery of child PTSD symptoms: a longitudinal analysis of children exposed to acute trauma

Background Higher levels of PTSD symptoms are present among trauma-exposed females v. males in adulthood; however, much less is known about the emergence of this sex difference during development. Methods In a multi-study sample of 7–18-year-olds (n = 3397), we examined the effect of sex and age on the severity of PTSD symptoms after a single incident trauma at 1 month (T1), and on symptom change after a natural recovery period of 3 (T2) and 6 months (T3). PTSD scores were harmonised across measurement types, and linear regressions were used to determine sex and age effects, adjusting for study level variance and trauma type. Results A sex × age interaction was observed at T1 (p < 0.001) demonstrating that older age was associated with greater PTSD symptom severity in females (β = 0.008, p = 0.047), but less severe symptoms in males (β = −0.011, p = 0.014). The same pattern was observed at T2 and T3, with sex differences beginning to emerge by age 12 years. PTSD symptoms decreased naturally by ~25% at T2 with little further improvement by T3. Further, females showed a greater reduction in symptoms at T3 than males, although the same effect was not observed at T2. Conclusions Sex differences in PTSD symptoms become apparent during adolescence, due to opposing changes in susceptibility occurring in females and males with age. Understanding the factors contributing to these findings is likely to provide wider insight into sex-specific psychological vulnerability to trauma-related psychopathology.

Prevalence and patterns of traumatic dental injuries in primary teeth: a 3-year retrospective overview study in Vienna

Objectives The aim of this study was to retrospectively identify the prevalence, patterns, and accident types of traumatic dental injuries (TDIs) in children with primary teeth in Vienna, Austria. Material and methods The investigation was conducted as a retrospective overview study including all children with TDIs in primary teeth at the University Dental Clinic of Vienna (Austria) between 2014 and 2016. Dental records including age, gender, location of trauma, type of trauma, cause of TDI, and location of traumatic incident were obtained. Furthermore, the time of presentation and the time span between TDI and initial treatment were evaluated. Results The sample comprised TDIs in 243 patients with 403 primary teeth. In a ratio of 1:1.45, boys were significantly more involved than girls. Upper central and lateral incisors were most frequently affected (n = 371, 92.1%). Dislocations were the most common type of injury (n = 298, 74%) with subluxations being the most prevalent form (n = 85, 28.5%). In 23% (n = 92), fractures were observed. The majority of traumatic incidents occurred at home (88.5%). Conclusion The injury characteristics are comparable to what has previously been reported in other studies in pediatric populations. Clinical relevance TDIs are a prevalent event in children worldwide and incisors are the most affected teeth in the primary dentition. Thus, dental practitioners should be able to handle these injuries.

PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies

Objective: Sexual assault is associated with higher rates of posttraumatic stress disorder (PTSD) than other traumas, and the course of PTSD may differ by trauma type. However, the course of PTSD after sexual assault has not been summarized. The aim of this meta-analysis was to identify the prevalence and severity of PTSD and changes to the average rate of recovery in the 12 months following sexual assault. Method: Authors searched four databases for prospective studies published before April 2020 and sought relevant unpublished data. Eligible studies assessed PTSD in at least 10 survivors of sexual assault in at least two time points, starting within 3 months postassault. Random effects linear-linear piecewise models were used to identify changes in average recovery rate and produce model-implied estimates of monthly point prevalence and mean symptom severity. Results: Meta-analysis of 22 unique samples ( N = 2,106) indicated that 74.58% (95% confidence interval [CI]: [67.21, 81.29]) and 41.49% (95% CI: [32.36, 50.92]) of individuals met diagnostic criteria for PTSD at the first and 12th month following sexual assault, respectively. PTSD symptom severity was 47.94% (95% CI: [41.27, 54.61]) and 29.91% (95% CI: [23.10, 36.73]) of scales’ maximum severity at the first and 12th month following sexual assault, respectively. Most symptom recovery occurred within the first 3 months following sexual assault, after which point the average rate of recovery slowed. Conclusions: Findings indicate that PTSD is common and severe following sexual assault, and the first 3 months postassault may be a critical period for natural recovery.

The relationship between psychosocial trauma type and conversion (functional neurological) disorder symptoms: a cross-sectional study

Objective: Psychosocial trauma was associated with developing conversion disorder (also known as functional neurological disorder) before Freud, though why a particular symptom should arise is unknown. We aimed to determine if there was a relationship between trauma type and symptom. Methods: We retrospectively reviewed the medical records of patients attending Australia’s first functional neurology clinic, including referral, clinic letters and a clinic questionnaire. Results: There were 106 females, 43 males and five transgender patients. Sensory (51%), motor (47%) and seizures (39%) were the commonest functional symptoms. Most patients (92%) reported stressors associated with symptom onset. Multiple trauma/symptom type associations were found: patients with in-law problems experienced more cognitive symptoms ( p = .036), for example, while expressive speech problems more commonly followed relationship difficulties ( p = .021). Conclusion: Associations were found between type of traumatic events and type of symptoms in conversion disorder. This will require verification in a larger sample.

Timing and Dose of Pharmacological Thromboprophylaxis in Adult Trauma Patients: Perceptions, Barriers, and Experience of Saudi Arabia Practicing Physicians

BackgroundPharmacological venous thromboembolism prophylaxis (PVTE-Px) in trauma care is challenging and frequently delayed until post injury bleeding risk is perceived to be sufficiently low; yet data for optimal initiation time is lacking. This study assessed practice pattern of PVTE-Px initiation time and dose in traumatic brain injury (TBI), spinal cord injury (SCI), and non-operative (NOR) solid organ injuries.MethodsMulticenter, cross sectional, observational, survey-based study involving intensivists, trauma surgeons, general surgeons, spine orthopedics, and neurosurgeons practicing in trauma centers. The data of demographics, PVTE-Px timing and dose, and five clinical case scenarios were obtained. Analyses were stratified by early initiators vs. late initiators and logistic regression models were used to identify factors associated with early initiation of PVTE-Px.ResultsOf 102 physicians (29 % response rate), most respondents were intensivists (63.7%) and surgeons (who are general and trauma surgeons) (22.5%); majority were consultants (58%), practicing at level 1 trauma centers (40.6%) or academic teaching hospitals (45.1%). A third of respondents (34.2%) indicated that decision to initiate PVTE-Px in TBI and SCI was made by a consensus between surgical, critical care, and neurosurgical services. For patients with NOR solid organ injuries, 34.2% of respondents indicated trauma surgeons initiated the decision on PVTE-Px timing. About 53.7% of the respondents considered their PVTE-Px practice as appropriate, half used combined mechanical and PVTE-Px (57.1%), 52% preferred enoxaparin (40 mg once daily), and only 6.5% used anti-Xa level to guide enoxaparin prophylactic dose. Responses to clinical cases varied. For TBI and TBI with intracranial pressure monitor, 40.3% and 45.6% of the respondents were early initiators with stable repeated head computed tomography [CT], respectively. For SCI, most respondents were early initiators without repeated CT spine (36.8%). With regards to NOR solid organ injuries [gunshot wound to the liver and grade IV splenic injuries], 49.1% and 36.4% of respondents were early initiators without a repeat CT abdomen.ConclusionsVariations were observed in PVTE-Px initiation time influenced by trauma type. Our findings suggested enoxaparin is preferred in a standard prophylactic dose. More robust data from randomized trials are needed and the use of clinicians’ judgment is recommended.Key MessagesIdeal time to initiate therapy, agent selection, dosing, and monitoring of pharmacological venous thromboembolism prophylaxis (PVTE-Px) for trauma patients is challenging.Variations were observed in PVTE-Px initiation time influenced by trauma type.Our study results are relatively in line with the recent evidence-based clinical literatureOur findings suggested limited awareness of augmented renal clearance (ARC) and utilization of serum anti-factor-Xa (anti-Xa) level.

Pediatric Traumatic Cataracts : 10 Year-experience of a Tertiary Referral Center

Background: To evaluate the factors influencing final visual acuity in pediatric traumatic cataracts. Methods: Data of patients who presented with traumatic cataracts were reviewed retrospectively. We evaluated sex; age at trauma; trauma type, cause, and zone; duration between the time of trauma and cataract surgery; surgical method used; time, location, and type of intraocular lens (IOL) implantation; initial and final corrected distance visual acuity (CDVA); amblyopia rate and complications. Results: In all, 61 eyes of 59 patients with cataracts after trauma, under 16 years of age, were included. The mean age of the children was 7.2 ± 3.9 years. Primary IOL implantation was performed in 70.9% of eyes. The CDVA was 0.7 LogMAR or better in 16.3% of the 49 eyes where the visual acuity could be measured at the time of trauma and in 69.1% of 55 eyes in which it could be measured after treatment. The evaluation of factors potentially influencing the final visual acuity revealed that eyes that had undergone posterior capsulotomy (PC) and anterior vitrectomy (AV) during cataract surgery had significantly better final vision compared to eyes that did not undergo these procedures. Conclusion: Good visual results can be obtained in children with traumatic cataracts using PC and AV together with lens aspiration and IOL implantation, followed by effective amblyopia treatment and close monitoring.