Treatment delays in paediatric dento-alveolar trauma at a tertiary referral hospital

Background: Paediatric dento-alveolar trauma is a common event. Delays in treatment can have adverse effects on long term outcomes and the aim of this study was to quantify the treatment delays in paediatric dento-alveolar trauma in a tertiary referral hospital. Methods: All cases of paediatric dento-alveolar trauma over a two-year period from July 2000 to June 2002 were identified and the charts were reviewed retrospectively. All children presenting the emergency department with dento-alveolar trauma within 48 hours of injury during the time period were included. Results: Forty-three patients were identified. The average age was 5.51 years, though there was a bias towards one and two year olds. Males were injured 1.5 times more frequently than females. There was an average delay of 9.6 hours between injury and treatment for all patients. Transit time from outside practitioners to hospital and waiting times in hospital made up the greatest delays. Children injured an average of 2.37 teeth and only 14 per cent were uncomplicated crown fractures. Conclusions: Children who present to children's hospitals for treatment of dento-alveolar trauma have more severe injuries than those treated elsewhere. They have large but potentially reducible delays between injury and treatment.

Management of isolated orbital floor blow-out fractures: a survey of Australian and New Zealand oral and maxillofacial surgeons

Background: This is the first report of involvement of Australian and New Zealand oral and maxillofacial surgeons in the management of isolated orbital floor blow-out fractures and was conducted to obtain comparisons with the results from a recent similar survey of British oral and maxillofacial surgeons. Methods: A questionnaire survey was sent to all 113 practising members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons in April 2002 with a second mailout 1 month later. Results: Sixty-nine per cent of the respondents were referred isolated orbital floor blow-out fractures for manage-ment, and just over half of these respondents estimated that 50% or more of the cases went to surgery. The materials most commonly used in orbital floor reconstruction were resorbable membrane for small defects and autologous bone for large defects. Conclusion: As in Britain, management of isolated orbital floor blow-out fractures comprises part of the surgical spectrum for many oral and maxillofacial surgeons in Australia and New Zealand. The management protocol was observed to be very similar between the two groups.

Trauma-induced central diabetes insipidus in a cat

A 1-year-old neutered male domestic shorthair cat presented with a 4-week history of polydipsia that began immediately after an 8 metre fall, Trauma-induced central diabetes insipidus was suspected on the basis of the identification of hyposthenuria, normal haematology and serum biochemistry profile and unremarkable abdominal ultrasound examination. Failure to concentrate urine with water deprivation followed by production of hypersthenuric urine with administration of the synthetic antidiuretic hormone, Deamino-8-D-arginine vasopressin (DDAVP), confirmed the diagnosis of central diabetes insipidus. Treatment via conjunctival administration of DDAVP failed to attenuate the polydipsia, however, resolution of polydipsia was achieved with subcutaneous administration of DDAVP and the cat remains eudipsic with twice daily subcutaneous DDAVP administration 17 months after diagnosis.

Psychopathology following trauma: The role of subjective experience

Background: The DSM-IV definition of posttraumatic stress disorder (PTSD) widened the stressor criterion to include objective (A1) and subjective (A2) components. The prevalence of Criterion A2, and its association with traumatic memory and psychopathology, was examined in a large community sample. Method: The presence of Criterion A2 and traumatic memories, as well as DSM-IV anxiety, affective and substance use disorders, were examined in a community sample of 6104 adults with a history of traumatic exposure. Results: Most individuals met Criterion A2 (76%), with higher prevalence in females (81%) than males (69%). A2 was more common following certain traumas (such as assaultive violence). Excluding those people with PTSD, prevalence of most psychiatric disorders was higher in those who met Criterion A2 than in those who only met Criterion A1. Only 3% of those who did not meet A2 went on to suffer persistent traumatic memories. The prevalence of psychiatric disorders was higher in those with A2 and traumatic memories than in those with A2 and no traumatic memories. Limitations: The retrospective nature of the data raises the potential for reporting biases. The data set allowed only one of several possible predictors of posttraumatic adjustment to be examined and only 12-month, and not lifetime, prevalence of psychiatric conditions was available. Conclusions: The experience of powerful emotions at the time of traumatic exposure is common and is associated with increased prevalence not only of PTSD, but also of a range of other psychiatric conditions. Traumatic memories may mediate this association. (c) 2005 Elsevier B.V. All rights reserved.

Epidemiology of open- and closed-globe trauma presenting to Cairns Base Hospital, Queensland

Purpose: To review the epidemiology of serious ocular trauma presenting to Cairns Base Hospital, from the far north Queensland health districts. Methods: A retrospective study of cases from January 1995 to November 2002 inclusive. Cases were analysed with respect to demographics, cause and nature of injury, method of transport and time to and type of ophthalmic treatment, and visual outcomes. Results: There were 226 cases identified, including 71 open-globe and 155 closed-globe injuries. The annual rate of injury was 3.7 per 100 000 for open-globe and 11.8 per 100 000 in total. The Aboriginal and Torres Strait Islander population from the far north Queensland districts showed a disproportionate incidence, with 38% of the total number of injuries, despite representing only 12.3% of the population. Assault in the Aboriginal and Torres Strait Islander population resulted in 69.6% of injuries in men and 75.8% of injuries in women. Of all assaults 76.2% were alcohol-related. The majority (71.5%) of injuries in the Caucasian population were due to accidental blunt and sharp trauma. In total, 77.4% of injuries occurred in men, with an average age of 31 years. Of all open and closed injuries in the study, a final visual acuity of 6/12 or better was achieved in 47.8% of eyes and a final visual acuity of 6/60 or less occurred in 17.7% of patients, 20.8% patients were lost to follow up. In total, 14.1% of open injuries required enucleation/evisceration. Conclusions: The incidence of ocular trauma in far north Queensland is equal to other Australian populations. However, there is a disproportionately high incidence in the Aboriginal and Torres Strait Islander population. Alcohol-related assault is a significant cause of visual loss in the Aboriginal and Torres Strait Islander population. Closed-globe injuries are more common than open globe; however, the latter have poorer visual prognosis. Initial visual acuity of all injuries correlated with final visual acuity.

Effect of information provision on trauma symptoms following therapeutic writing

Recent studies in the area of psychological debriefing (PD) have reported adverse effects. This study examined one possible explanation for such effects, that of sensitisation to the possibility of pathology. Subjects were 161 psychology students (female, n = 121; male, n = 40) who had experienced trauma but received no previous treatment. Subjects either received an explanation (explanation group) or received no explanation at all (no explanation group) about trauma reactions prior to undertaking a therapeutic writing protocol. The hypothesis of increased morbidity where the possibility of pathology was made explicit was not supported. At 2 months, the explanation group had a greater reduction on Impact of Events Scale Revised JES-R) total scores, F(1, 151) = 3.98, p = .048, and on the General Health Questionnaire - 28 (GHQ-28) Anxiety and Insomnia subscale, F(1, 151) = 9.84, p = .002, and total score F(1, 150) 5.05, p = .026. High-avoidance copers in particular appeared to benefit from information provision, F(1, 148) = 4.2 6, p = .044. Results suggest that adverse findings associated with PD may not be due to information sensitising of participants to pathology and that the provision of information to trauma survivors appears to be a useful strategy. Recommendations were made regarding the management of those exposed to trauma and for future research.

The role of avoidance coping in the disclosure of trauma

Little research has been undertaken to examine the empirical basis of commonly applied methods of posttrauma intervention. We propose that Pennebaker's work on structured disclosure of trauma provides a suitable analogue to explore questions of interest. The present study asks whether avoidance coping is likely to interfere with abbreviated disclosure of traumatic experiences. Subjects were 118 college students randomly allocated to either a one-session or four-session written trauma-disclosure condition. At 2 months postdisclosure, subjects with high avoidance coping within the one-session condition exhibited significantly more trauma-specific and physical symptoms than all other subjects. Avoidance coping significantly predicted trauma-specific symptoms at 2 months. These findings suggest that single session traumatic disclosure may not be useful for individuals with an avoidance style of coping.