Characterizing the frequency, morbidity, and types of traumatic brain injuries after the Mexico-San Diego border wall extension: a retrospective cohort review

Clinician perspectives on characteristics and care of traumatic brain injury among asylum seekers and refugees

PURPOSE

Traumatic brain injury (TBI) disproportionately affects asylum-seekers and refugees (ASR), although underdiagnosed and undertreated. Our study assesses clinicians' perspectives on characteristics and management of TBI among ASR, with the hope of improving TBI management in this population.

MATERIALS AND METHODS

We conducted six focus groups of 16 clinicians across two academic medical centers in Boston, Massachusetts, United States. Clinicians in our sample included primary care clinicians, nurse practitioners, social workers, psychologists, neurologists, psychiatrists, and neuropsychologists. We analyzed the qualitative data following a hybrid inductive-deductive thematic analytic approach.

RESULTS

Clinicians characterized TBI among ASR as mostly mild and remote, involving head strikes, perpetrated predominantly by interpersonal violence and strangulation-related brain injury, and involving symptom overlap with mental health diagnoses, challenging diagnosis. Clinicians also described inadequate screening, the importance of connecting the physical and psychological symptoms of the brain injury rather than viewing them as distinct, and addressing diagnosis-related stigma and shame. Finally, they discussed lack of TBI-specific knowledge among providers and patients alike, and resource limitations affecting the continuum of care for this population.

CONCLUSION

Integrating clinicians' perspectives in caring for this population allows us to best meet their needs, including in TBI recovery.

Traumatic Brain Injuries After Falls From Height vs Falls at the US-Mexico Border Wall

This cohort study examines the incidence, severity, and mortality of fall-related injuries among migrants at the US-Mexico border in San Diego, California.

Rate of Aquatic and Maritime Drowning Deaths After US-Mexico Border Wall Height Increase

This study assesses migratory drowning deaths along the southwest border of the US before and after the increase in border wall height.

A border health crisis at the United States-Mexico border: an urgent call to action

In this Viewpoint, we provide an overview of the worsening trend of traumatic injuries across the United States-Mexico border after its recent fortification and height extension to 30-feet. We further characterize the international factors driving migration and the current U.S. policies and political climate that will allow this public health crisis to progress. Finally, we provide recommendations involving prevention efforts, effective resource allocation, and advocacy that will start addressing the humanitarian and economic consequences of current U.S. border policies and infrastructure.

Increased Mortality and Morbidity Due to the Increase in Border Wall Height

Objective Our retrospective cohort study focuses on the differences in the severity of injuries sustained from border wall falls before and after wall height increase. Severity of injuries is categorized by injury severity score (ISS), length of stay in the hospital (LOS), ventilation, intensive care unit (ICU), and surgery. The purpose of this study is to underline the medical consequences of extending the US-Mexico border wall. Specifically, we focused on the severity of injuries that are seen in trauma centers near the US-Mexico border. We propose that the rise in trauma cases from the border wall is associated with the extension of the border wall.  Methods  This IRB-approved, retrospective cohort study included all patients that were admitted to Desert Regional Medical Center, a level 1 trauma center in Palm Springs, California, United States. Patients were admitted between March 2016 and December 2021, after sustaining a fall from the border wall. The fall of the height ranged from 15 to 30 feet. Patients were assigned to pre-2020 or post-2020 subgroups, based on time of admission. The total number of admissions, ISS, LOS, surgeries, ventilation, and ICU services were compared.  Results  Injuries from border wall falls grew 1250% from 2016 to 2021 (4 vs 50 admissions). When comparing the two subgroups, hospital admissions (20 vs 84) and ISS (9 vs 15) have also risen dramatically. Of all the variables compared, the days spent in the ICU proved to be statistically significant at a p-value of 0.02. Although the remaining data was not statistically significant, there still remains a trend of increasing injuries that are also more severe in presentation, requiring more interventions.  Conclusions The increase in border height has led to a record-high number of admissions and severity of injuries. This study shows that increasing the border wall height has led to a public health crisis and underlines the profound impact that political decisions have in the medical field.