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Enting M, de Jongh MAC, Joosen MCW, Bakker M, van der Kruijssen DTF, Geuze RE, Kupper N. The cross-sectional and longitudinal interconnectedness of physical, psychological and role functioning following physical trauma: A network analysis. J Psychosom Res 2024; 184:111833. [PMID: 38959575 DOI: 10.1016/j.jpsychores.2024.111833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/26/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Surviving physical trauma can have a large impact on one's daily life. Patients are at increased risk for poor physical health, psychological complaints, and problems in role functioning - which is often experienced simultaneously. The present study explores the interconnectedness of physical, psychological, and role functioning during the first two years post-injury, both cross-sectionally and longitudinally from a network perspective. METHODS 3785 trauma patients (Mage = 64.2 years, SDage = 18.9 years, 50.5% female) completed questionnaires on physical, psychological, and role functioning across six measurement occasions during the first two years post-injury. The Injury Severity Score (ISS) was retrieved from the local trauma registry. Mixed graphical network models and cross-lagged network models were estimated to examine which items of recovery played a central role and were mostly related to other items in cross-sectional and longitudinal networks respectively. RESULTS The cross-sectional networks showed especially strong interconnections between impairments of physical and role functioning and also within post-traumatic stress symptoms. The longitudinal networks extended these results by showing that pain, impaired mobility, limitations in self-care, anxiety/depressive symptoms, and several post-traumatic stress symptoms were strong predictors for impairments in functioning at later stages of recovery. CONCLUSION Our findings showed that impairments in physical, psychological, and role functioning experienced by trauma patients are largely intertwined across the two years following injury. Monitoring physical impairments and psychological complaints early in recovery might help to more promptly provide the best fitting aftercare for trauma patients, which can improve recovery on the long-term.
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Affiliation(s)
- Manon Enting
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Well-Being, the Netherlands; Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands.
| | | | - Margot C W Joosen
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Well-Being, the Netherlands
| | - Marjan Bakker
- Department of Methodology and Statistics, Tilburg University, the Netherlands
| | | | - Ruth E Geuze
- Department of Orthopedics, ETZ Hospital, Tilburg, the Netherlands
| | - Nina Kupper
- Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
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Yadav S, Rawal G. Advances in Understanding and Managing Floating Knee Injuries: A Comprehensive Review. Cureus 2024; 16:e57122. [PMID: 38681444 PMCID: PMC11055540 DOI: 10.7759/cureus.57122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Fractures of the ipsilateral tibia and femur, frequently combined with soft tissue damage and dislocations, describe floating knee injuries, a complicated orthopedic condition. Epidemiological data suggest that floating knee injuries account for a small but significant proportion of traumatic orthopedic injuries, with a higher incidence observed in younger males engaged in high-risk activities. Anatomically, floating knee injuries involve fractures of the femur and tibia, ligamentous disruptions, and soft tissue damage, contributing to the complexity and severity of these injuries. An extensive analysis of floating knee injuries is given in this paper, including information about epidemiology, anatomy, pathophysiology, categorization, management approaches, complications, prognosis, and current and upcoming developments.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| | - Gautam Rawal
- Respiratory Medical Critical Care, Max Super Speciality Hospital, New Delhi, IND
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Walker J. Assessment and management of fractures. Br J Community Nurs 2023; 28:352-358. [PMID: 37369437 DOI: 10.12968/bjcn.2023.28.7.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Fractures can have significant impact on function and quality of life, and an cause significant disruption to psychological and social wellbeing. A systematic approach is required for the assessment and management of fractures to ensure effective and timely recovery. Nurses play a key role in the care continuum to support the acute and rehabilitation phases of recovery. The use of Patient Reported Outcome Measures ensure a patient-centred approach to management, gauge progress and identify actions needed to optimise recovery. This article outlines the assessment and management of fractures, common concerns and potential complications.
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Affiliation(s)
- Jennie Walker
- Institute of Health and Allied Professions, Nottingham Trent University, UK
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Lindahl M, Juneja H. I'll be back - Predictive validity of adults' expectations for recovery after fractures - A longitudinal observational study. Injury 2023:S0020-1383(23)00246-2. [PMID: 36925373 DOI: 10.1016/j.injury.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Recovery after fractures due to accidents relates to all aspects of the biopsychosocial model. Therefore, it is difficult for the patients to foresee the consequences of the fractures. This study aimed to examine 1) patients' expectations regarding the impact of the injury on everyday life, 2) predictive validity of their expectations after six months, and 3) factors that predict a return to work. PATIENTS AND METHODS Patients were 18-64 years old and hospitalized with simple or compound/multiple fractures due to an accident. During admission, structured interviews were conducted with a questionnaire covering working conditions, expectations regarding recovery, sports, economy, family, household, and return to work. Additionally, mental and physical status were covered with Short Musculoskeletal Function Assessment questionnaire (SMFA) and Short Form 36, and working conditions were uncovered too. After six months, telephonic interviews were conducted with the 164 available patients to elucidate the impact of the fractures on everyday life, their health status, and sick leave. Likelihood ratios, post-test probabilities, and logistic regression analysis were performed to establish if patients' expectations predicted recovery, economy, sports, family, household, and return to work. RESULTS Few patients' baseline expectations about everyday life were met. The likelihood ratios were small, and the post-test probabilities for expectations consistent with outcomes were between 18% and 68%, with recovery as the lowest and participation in sports as the highest. In the multivariate analysis, patients' expectations did not predict short-term (less than two months) or long-term sick leave (more than three months). Self-rated health and the bother index of SMFA were significant short-term and long-term predictors for sick leave. Additionally, vitality, pain, and decision latitude at work predicted sick leave of less than two months. CONCLUSION A few days after the accident, patients' expectations about everyday life are not associated with outcomes six months later. Likelihood ratios indicate difficulties for the patients in predicting fractures' consequences on various aspects of everyday life. Return to work was associated with self-rated health and the bother index of SMFA. Future research should examine if fracture patients can benefit from comprehensive, individual counseling during admission to set appropriate expectations.
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Affiliation(s)
- Marianne Lindahl
- Centre for Health and Rehabilitation, University College Absalon, Slagelse, Denmark.
| | - Hemant Juneja
- Centre for Health and Rehabilitation, University College Absalon, Slagelse, Denmark
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Olive P, Hives L, Ashton A, O’Brien MC, Taylor A, Mercer G, Horsfield C, Carey R, Jassat R, Spencer J, Wilson N. Psychological and psychosocial aspects of major trauma care: A survey of current practice across UK and Ireland. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086221145529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction Psychological and psychosocial impacts of major trauma, defined as any injury that has the potential to be life-threatening and/or life changing, are common, far-reaching and often enduring. There is evidence that these aspects of major trauma care are often underserved. The aim of this research was to gain insight into the current provision and operationalisation of psychological and psychosocial aspects of major trauma care across the UK and Ireland. Methods A cross-sectional online survey, open to health professionals working in major trauma network hospitals was undertaken. The survey had 69 questions across six sections: Participant Demographics, Psychological First Aid, Psychosocial Assessment and Care, Assessing and Responding to Distress, Clinical Psychology Services, and Major Trauma Keyworker (Coordinator) Role. Results There were 102 respondents from across the regions and from a range of professional groups. Survey findings indicate a lack of formalised systems to assess, respond and evaluate psychological and psychosocial aspects of major trauma care, most notably for patients with lower-level distress and psychosocial support needs, and for trauma populations that don't reach threshold for serious injury or complex health need. The findings highlight the role of major trauma keyworkers (coordinators) in psychosocial aspects of care and that although major trauma clinical psychology services are increasingly embedded, many lack the capacity to meet demand. Conclusion Neglecting psychological and psychosocial aspects of major trauma care may extend peritraumatic distress, result in preventable Years Lived with Disability and widen post-trauma health inequalities. A stepped psychological and psychosocial care pathway for major trauma patients and their families from the point of injury and continuing as they move through services towards recovery is needed. Research to fulfil knowledge gaps to develop and implement such a model for major trauma populations should be prioritised along with the development of corresponding service specifications for providers.
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Affiliation(s)
- P Olive
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - L Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - A Ashton
- Psychology Service, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - MC O’Brien
- Neuropsychology Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - A Taylor
- Trauma Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - G Mercer
- Acute Rehabilitation Trauma Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - C Horsfield
- West Yorkshire Critical Care & Major Trauma Operational Delivery Networks and South Yorkshire & Bassetlaw Critical Care ODN, Leeds, UK
| | - R Carey
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - R Jassat
- School of Medicine, University of Central Lancashire, Preston, UK
| | - J Spencer
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - N Wilson
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
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Keles A, Karayagmurlu A, Yetkin E, Sonmez K, Karatepe MS, Karaman SK. Development of posttraumatic stress disorder and depression after open globe injury in adults. Graefes Arch Clin Exp Ophthalmol 2023; 261:257-262. [PMID: 35939121 DOI: 10.1007/s00417-022-05792-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To investigate the prevalence of posttraumatic stress disorder (PTSD) and depression after open globe injury in adults. METHODS A total of 95 participants, 43 adult patients with open globe injury and 52 age-sex similar subjects (control group), were included in this cross-sectional study. Age, gender, education level, occupation, accident history, psychiatric history, trauma type, cause of trauma, and visual acuity were recorded. One to six months after trauma, PTSD and depression symptoms of the participants were evaluated with the Posttraumatic Stress Disorder Questionnaire-Civil Version Scale (PTSD-S) and Beck Depression Inventory (BDI), respectively. RESULTS Patients with open globe injury had a higher PTSD-S total score than the control group, but not significant (23.67 ± 20.41 vs. 18.56 ± 13.13, p = 0.580). Patients with eye trauma exhibited a much higher prevalence of PTSD compared to the control group (20.9% vs. 3.8%, p = 0.010). Patients with trauma had a significantly higher BDI total score than the control group (12.47 ± 10.08 vs. 7.69 ± 6.10, p = 0.015). Also, patients had a higher rate of depression symptoms than controls (25.6% vs. 7.7%, p = 0.017). A significant positive correlation was observed between PTSD-S and BDI scores in the trauma group (r = 0.720, p < 0.001). CONCLUSION An increased prevalence of PTSD and depression was observed in adults after open globe injury. The significant relationship between PTSD-S and BDI scores indicates that patients with open globe injuries should be questioned in terms of both symptoms. For patients with open globe trauma, a holistic approach with psychosocial assessment in addition to physical intervention would be beneficial.
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Affiliation(s)
- Ali Keles
- Department of Ophthalmology, Faculty of Medicine, Bilecik Seyh Edebali University, 11230, Bilecik, Turkey.
| | - Ali Karayagmurlu
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esat Yetkin
- Department of Ophthalmology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Kenan Sonmez
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mustafa Salih Karatepe
- Department of Ophthalmology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - Suleyman Korhan Karaman
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Gavin JP, Kettlewell J, Elliott AO, Ammour S, Wareham P. Priorities for returning to work after traumatic injury: A public and professional involvement study. Br J Occup Ther 2022. [DOI: 10.1177/03080226221107772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Following traumatic injury, occupational therapists (OTs) are pivotal in supporting people to return-to-work (RTW) and regain independence. Aim: to identify priorities for RTW after traumatic injury and highlight barriers hindering the process. Method We recruited 17 participants with direct (i.e. trauma survivor [ n = 11]; OT trauma survivor [ n = 2]) or indirect (i.e. OT [ n = 4]) experience of returning to work following traumatic injury. Online consultations, lasting 60 min, were guided by a semi-structured script ensuring relevant topics were covered. An inductive approach was used for coding themes using thematic analysis. Findings Sense of purpose, identity and social interaction were greater priorities for RTW, than financial stability. Major barriers were: pain and fatigue; adapting to physical changes; impacts on mental health; and lack of support (healthcare and the workplace). Participants (public and healthcare professionals) reported a lack of vocational rehabilitation in supporting trauma survivors RTW, but advocated occupational therapy for psychological recovery; purposeful engagement in occupations; and community support. Conclusion Restoring an individual’s self-identity and social connections, whilst helping control pain and fatigue, should be prioritised when planning occupational therapy for those returning to work after traumatic injury. This study was limited to ‘returners’, but can inform occupational therapy interventions for RTW.
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Affiliation(s)
- James P Gavin
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jade Kettlewell
- School of Social Sciences, University of Nottingham, Nottingham, UK
| | - Abigail O Elliott
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Sandra Ammour
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
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Olive P, Hives L, Wilson N, Ashton A, O’Brien MC, Mercer G, Jassat R, Harris C. Psychological and psychosocial aspects of major trauma care in the United Kingdom: A scoping review of primary research. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221104934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction More people are surviving major trauma, often with life changing injuries. Alongside physical injury, many survivors of major trauma experience psychological and psychosocial impacts. Presently, there is little guidance at the UK national level for psychological and psychosocial aspects of major trauma care. Set in the context of the regional model of major trauma care implemented in the UK in 2012, the purpose of this review was to identify and bring together primary research about psychological and psychosocial aspects of major trauma care in the UK to produce an overview of the field to date, identify knowledge gaps and set research priorities. Methods A scoping review was undertaken. Seven electronic databases (MEDLINE, Cochrane Library, CINAHL, Embase, PsycINFO, SocINDEX with Full Text and PROSPERO) were searched alongside a targeted grey literature search. Data from included studies were extracted using a predefined extraction form and underwent bibliometric analysis. Included studies were then grouped by type of research, summarised, and synthesised to produce a descriptive summary and overview of the field. Results The searches identified 5,975 articles. Following screening, 43 primary research studies were included in the scoping review. The scoping review, along with previous research, illustrates that psychological and psychosocial impacts are to be expected following major trauma. However, it also found that these aspects of care are commonly underserved and that there are inherent inequities across major trauma care pathways in the UK. Conclusion Though the scoping review identified a growing body of research investigating psychological and psychosocial aspects of major trauma care pathways in the UK, significant gaps in the evidence base remain. Research is needed to establish clinically effective psychological and psychosocial assessment tools, corresponding interventions, and patient-centred outcome measures so that survivors of major trauma (and family members or carers) receive the most appropriate care and intervention.
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Affiliation(s)
- Philippa Olive
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Lucy Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Neil Wilson
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Amy Ashton
- Clinical Health Psychology Service, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Marie Claire O’Brien
- Neuropsychology Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Gemma Mercer
- Acute Rehabilitation Trauma Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Raeesa Jassat
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Catherine Harris
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, UK
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Roodbeen RTJ, Lugtenberg M, Pöstges H, Lansink KWW, Theeuwes HP, de Jongh MAC, Joosen MCW. Experiences of recovery and posthospital care needs of working-age adults after physical trauma: a qualitative focus group study. BMJ Open 2022; 12:e053330. [PMID: 35443944 PMCID: PMC9021804 DOI: 10.1136/bmjopen-2021-053330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore experiences of recovery after physical trauma and identify long-term needs for posthospital care. DESIGN, PARTICIPANTS AND SETTING A qualitative study was conducted consisting of seven online focus groups among working-age adults who sustained their injury between 9 months and 5 years ago. Trauma patients discharged from a level 1 trauma centre in the Netherlands were divided into three groups based on the type of their physical trauma (monotrauma, polytrauma and traumatic brain injury). Group interviews were transcribed verbatim, and thematic analysis was conducted. RESULTS Despite differences in type and severity of their injuries, participants all struggled with the impact that trauma had on various aspects of their lives. They experienced recovery as an unpredictable and inconstant process aimed at resuming a meaningful life. Work was often perceived as an important part of recovery, though the value attributed to work could change over time. Participants struggled to bring the difficulties they encountered in their daily lives and at work to the attention of healthcare professionals (HCPs). While posthospital care needs varied between and across groups, all people stressed the need for flexible access to person-centred, multidisciplinary care and support after hospital discharge. CONCLUSIONS This study reveals that people with a broad variety of injury experience recovery as a process towards resuming a meaningful life and report the need to expand trauma care to include comprehensive support to live well long term. Person-centred care might be helpful to enable HCPs to take people's individual long-term needs and life situations into account. Furthermore, providing timely access to coordinated, multidisciplinary care after discharge is advocated. Integrated care models that span a network of multidisciplinary support around the person may help align existing services and may facilitate easy and timely access to the most suitable support for injured people and their loved ones.
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Affiliation(s)
- Ruud T J Roodbeen
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
- Research Department, Breuer&Intraval Research and Consultancy, Groningen, The Netherlands
| | - Marjolein Lugtenberg
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
| | - Heide Pöstges
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
| | - Koen W W Lansink
- Department Trauma Topcare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
- Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Hilco P Theeuwes
- Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Mariska A C de Jongh
- Department Trauma Topcare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
| | - Margot C W Joosen
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
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