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Trauma

In medicine, trauma most commonly refers to physical injuries caused by sudden external forces, such as accidents or violence, and psychological distress resulting from exposure to threatening or overwhelming events that shatter an individual's sense of safety and worldview; the term is also used in contexts such as arts, entertainment, media, and sports. Physical trauma is defined as a tissue injury occurring abruptly due to violence or accident, which triggers the body's hypothalamic-pituitary-adrenal axis, immunologic, and metabolic responses to restore homeostasis.^[1] In the United States, physical trauma is the leading cause of death among individuals aged 1 to 46 years and accounts for approximately 10% of all deaths across all ages.^[2] Common types include penetrating trauma from objects piercing the body, blunt trauma from impacts like motor vehicle collisions, and deceleration trauma from sudden stops causing internal injuries such as aortic tears.^[1] Psychological trauma, in contrast, arises as an emotional response to distressing events like accidents, crimes, natural disasters, or sexual violence, often evoking intense fear, helplessness, dissociation, or confusion that disrupts daily functioning and long-term attitudes toward the world; recent events like the COVID-19 pandemic have further increased its prevalence.^[3] These events can be experienced directly, witnessed, or learned about indirectly, and they may involve actual or threatened death, serious injury, or harm.^[4] Immediate reactions typically include shock, denial, or autonomic nervous system activation (e.g., fight-or-flight responses), while prolonged effects can manifest as persistent stress, anxiety, or emotional numbness interfering with relationships and work.^[5] If symptoms endure beyond a month, they may indicate post-traumatic stress disorder (PTSD), a condition affecting approximately 5% of U.S. adults in any given year (as of 2020), with higher risks among those with prior traumas, especially in childhood.^[6] The impacts of trauma extend beyond the individual, influencing public health through increased risks of co-occurring conditions like depression, substance use, and chronic physical ailments, while also straining healthcare systems via emergency responses and long-term therapies.^[7] Both physical and psychological traumas often intersect, as severe injuries can precipitate mental health crises, and untreated psychological effects may exacerbate physical recovery.^[8] Effective management requires multidisciplinary approaches, including trauma-informed care that recognizes the pervasive nature of these experiences to prevent re-traumatization.^[9]

Medicine

Physical trauma

Physical trauma encompasses bodily damage resulting from external mechanical forces, such as those causing blunt or penetrating injuries, and excludes harm arising from disease or internal physiological processes. This type of injury occurs suddenly due to violence, accidents, or other external events, leading to disruption of tissues, organs, or bodily structures.^[1] Primary injuries represent the direct mechanical damage at the moment of impact, while secondary injuries involve subsequent complications, including hypovolemic shock, infection, or organ ischemia triggered by the initial trauma.^[10] Classifications also categorize trauma by mechanism—blunt (e.g., from impacts without skin breach), penetrating (e.g., from projectiles or sharp objects), and deceleration (e.g., from sudden stops)—or by affected body region, such as head, chest, or abdominal trauma, to guide clinical evaluation and management.^[1]^[11] Common causes of physical trauma include motor vehicle accidents, falls from heights, interpersonal assaults, and penetrating wounds from firearms or stabbings, which account for a significant portion of cases globally. Mechanisms of injury primarily involve the transfer of kinetic energy, where the energy from an external force (e.g., a collision) deforms tissues, leading to contusions, fractures, or lacerations; deceleration forces, as in high-speed crashes, cause shearing or tearing of internal structures like blood vessels or the spinal cord; and other forms such as crush injuries from compressive loads or blast trauma from explosive pressure waves.^[12]^[13] For instance, in motor vehicle collisions, rapid deceleration can result in aortic tears due to inertial forces on the body's momentum.^[14] Initial assessment follows the ABCDE protocol established in Advanced Trauma Life Support (ATLS) guidelines, prioritizing Airway management to ensure patency, Breathing evaluation for oxygenation, Circulation assessment for hemorrhage control, Disability check via neurological exam (e.g., Glasgow Coma Scale), and Exposure to identify hidden injuries while preventing hypothermia.^[15] Severity is quantified using scoring systems like the Injury Severity Score (ISS), calculated as the sum of the squares of the Abbreviated Injury Scale (AIS) scores for the three most severely injured body regions (ISS ranges from 0 to 75, with scores ≥16 indicating severe trauma):

\text{ISS} = (\text{AIS}_{\text{region 1}})^2 + (\text{AIS}_{\text{region 2}})^2 + (\text{AIS}_{\text{region 3}})^2

where AIS grades injuries from 1 (minor) to 6 (unsurvivable).^[16] The Revised Trauma Score (RTS) provides a physiological measure, combining coded values for Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR) (RTS ranges from 0 to 12, with lower scores predicting higher mortality):

\text{RTS} = 0.9368 \times \text{GCS code} + 0.7326 \times \text{SBP code} + 0.2908 \times \text{RR code}

These tools aid in triage and prognosis.^[17] Epidemiologically, physical trauma ranks as a leading cause of death for individuals aged 1–46 years, surpassing other conditions in this demographic due to its acute nature. Worldwide, injuries contribute to approximately 4.4 million deaths annually, representing nearly 8% of all global mortality, with road traffic incidents and falls being predominant in low- and middle-income countries.^[18]^[12] Psychological trauma may emerge as a secondary effect in survivors, influencing long-term recovery.^[1]

Psychological trauma

Psychological trauma refers to a damaging emotional and psychological experience resulting from exposure to severe distressing events, such as violence, accidents, or natural disasters, that overwhelm an individual's ability to cope or integrate the experience into their sense of self.^[3] These events typically involve actual or threatened death, serious injury, or sexual violence, either directly experienced, witnessed, or learned about occurring to a close family member or friend.^[19] Unlike everyday stress, psychological trauma disrupts core beliefs about safety, trust, and control, leading to profound and lasting effects on mental health.^[20] Psychological trauma manifests in several types, distinguished by the nature and duration of exposure. Acute trauma arises from a single overwhelming event, such as a car accident or assault, producing immediate and short-term distress that may resolve or evolve if unaddressed.^[8] Chronic trauma involves prolonged or repeated exposure to stressors, like living in a war zone or enduring ongoing domestic violence, which can erode resilience over time.^[8] Complex trauma, often resulting from sustained interpersonal abuse such as childhood neglect or repeated sexual exploitation, leads to multifaceted disruptions in emotional regulation, relationships, and self-concept.^[21] Secondary or vicarious trauma occurs in individuals indirectly exposed through their work, such as first responders or therapists hearing graphic accounts of others' suffering, resulting in empathetic absorption of traumatic material and similar symptomology.^[22] The causes of psychological trauma stem from events that shatter one's perceived security, ranging from singular incidents like physical assault to cumulative adversities such as prolonged poverty or combat deployment.^[7] Risk factors influencing vulnerability include younger age at exposure, pre-existing mental health conditions like depression, and limited social support networks, which can amplify the impact and hinder recovery.^[23] Conversely, protective factors such as strong community ties or prior coping skills may mitigate severity, though no individual is immune to sufficiently intense stressors.^[24] Symptoms of psychological trauma align with criteria outlined in the DSM-5-TR (updated through 2022), clustering into four main categories that must persist for more than one month to indicate a disorder. Intrusion symptoms include recurrent distressing memories, flashbacks, or nightmares that relive the event, often triggered by reminders.^[19] Avoidance involves deliberate efforts to evade trauma-related thoughts, feelings, or external cues, such as places or conversations associated with the event. Negative alterations in cognitions and mood manifest as persistent guilt, shame, detachment from others, or diminished interest in activities, fostering emotional numbness.^[19] Hyperarousal and reactivity appear as irritability, hypervigilance, exaggerated startle responses, concentration difficulties, or sleep disturbances, reflecting a heightened state of alertness. Psychological trauma frequently precipitates post-traumatic stress disorder (PTSD), a chronic condition diagnosed when exposure to a traumatic event is followed by the above symptoms lasting over one month, causing significant impairment in social, occupational, or other functioning.^[19] The DSM-5-TR specifies that PTSD requires direct or indirect exposure plus at least one symptom from each category (intrusion, avoidance, negative cognitions/mood, arousal), distinguishing it from acute stress disorder, which shares symptoms but resolves within a month. While not all trauma leads to PTSD, unprocessed trauma increases risk for comorbid conditions like depression or substance use disorders, underscoring the pathway from acute response to diagnosable pathology.^[25] Neurobiologically, psychological trauma alters key brain structures and stress response systems. The amygdala, central to fear processing, exhibits hyperactivity, leading to exaggerated threat detection and emotional reactivity long after the event.^[26] This is coupled with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, the body's primary stress pathway, resulting in abnormal cortisol release—often initially elevated but chronically blunted in PTSD, impairing stress adaptation.^[27] Such changes also affect the hippocampus, involved in memory consolidation, potentially shrinking its volume and contributing to fragmented recall of traumatic memories.^[26] Epidemiologically, PTSD—a primary outcome of psychological trauma—affects approximately 6-8% of the population over a lifetime, with higher rates among women (around 8%) compared to men (4%), attributable to greater exposure to interpersonal violence.^[28] In the United States, lifetime prevalence stands at about 6.8%, per National Institute of Mental Health data.^[25] The COVID-19 pandemic from 2020 onward contributed to increases in PTSD prevalence in certain affected populations, with some studies reporting rates of 15-30%, such as among healthcare workers, due to widespread fear, loss, and isolation.^[29]^[30]

Trauma care

Trauma care encompasses organized systems and protocols designed to manage injured patients from the scene of injury through recovery, emphasizing rapid response and multidisciplinary coordination to optimize outcomes. Regional trauma systems, as standardized by the American College of Surgeons (ACS), classify centers into Levels I through IV based on resources, volume, and capabilities, with Level I facilities providing comprehensive care including 24-hour in-house coverage, research, and education for the most complex cases, while Level IV centers focus on initial stabilization and transfer.^[31]^[32] These standards, revised in July 2025, ensure performance improvement, data collection, and protocols to enhance care quality across the continuum. The July 2025 revision includes minor clarifications but maintains core requirements from prior versions.^[32]^[33] Pre-hospital care begins with emergency medical services (EMS) personnel who perform triage using the Simple Triage and Rapid Treatment (START) system, a widely adopted algorithm in the United States that categorizes patients into immediate, delayed, minimal, or expectant groups based on respirations, perfusion, and mental status to prioritize transport during mass casualties or single incidents.^[34] Transport decisions prioritize higher-level centers for patients with unstable vital signs, high-energy mechanisms, or penetrating injuries, aiming to minimize the "golden hour" delay in definitive care.^[35] In the hospital, trauma teams comprising surgeons, nurses, anesthesiologists, and support staff activate based on criteria such as systolic blood pressure below 90 mmHg, heart rate over 120 beats per minute, penetrating torso injuries, or falls from height, triggering a coordinated response for immediate assessment. Care progresses through phases: initial resuscitation to stabilize airway, breathing, and circulation; operative intervention if needed; and intensive care unit (ICU) monitoring for ongoing support, with the trauma surgeon leading to integrate diagnostics and interventions.^[36] Specific treatments include damage control surgery (DCS), which prioritizes abbreviated procedures like packing or temporary shunting to control hemorrhage and contamination, followed by physiological correction in the ICU before definitive repair, reducing mortality in exsanguinating patients.^[37] Fluid resuscitation follows permissive hypotension guidelines, targeting systolic blood pressure of 80-90 mmHg preoperatively to avoid clot disruption and reperfusion injury, except in traumatic brain injury where higher pressures are maintained.^[38] Pain management employs multimodal protocols, combining acetaminophen, NSAIDs, and regional blocks with judicious opioids to minimize respiratory depression and facilitate mobility, as outlined in ACS best practices.^[39] Rehabilitation involves multidisciplinary teams including physical therapists, occupational therapists, and psychologists to restore function post-acutely, with early mobilization protocols preventing complications like deep vein thrombosis (DVT), infections, and muscle atrophy, thereby shortening hospital stays.^[40] Global disparities persist in low-resource settings, where the World Health Organization (WHO) promotes essential trauma care through standardized kits for airway management, hemorrhage control, and basic imaging, alongside training programs to build capacity, as updated in ongoing initiatives through 2024.^[41] Innovations include telemedicine for rural trauma response, enabling real-time consultation between remote EMS and urban specialists to guide triage and stabilization, reducing transfer times and improving survival.^[42] AI-assisted triage tools, such as those from Viz.ai, analyze vital signs and injury patterns to prioritize patients, enhancing efficiency in overburdened emergency departments while complementing human judgment, as implemented to meet ACS standards as of 2023.^[43]

Medical journals

Medical journals dedicated to trauma serve as vital platforms for advancing evidence-based practices in the management of injured patients, emphasizing interdisciplinary research across surgery, emergency medicine, and critical care to improve outcomes in acute settings. These publications facilitate the sharing of clinical trials, epidemiological data, and innovative protocols, bridging gaps between military-derived techniques and civilian applications to standardize care globally.^[44] Among the major journals, the Journal of Trauma and Acute Care Surgery, established in 1961 by the American Association for the Surgery of Trauma, focuses on acute injury management, including surgical interventions and critical care, with a 2024 impact factor of 3.7.^[45] The Trauma journal, published by Sage since 1999, emphasizes pre-hospital care, rehabilitation, and regional perspectives from the UK and Europe, achieving an impact factor of 0.7 in 2024.^[46] The European Journal of Trauma and Emergency Surgery, launched in 2005 as the official organ of the European Society for Trauma and Emergency Surgery, highlights multidisciplinary approaches to emergency care and diagnostics, with a 2024 impact factor of 2.2.^[47] Other notable journals include the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, founded in 2008 as an open-access outlet with a focus on pre-hospital and resuscitation strategies, boasting a 2024 impact factor of 3.1.^[48] Additionally, Trauma Surgery & Acute Care Open, initiated by BMJ in 2016, provides free global access to epidemiological, educational, and socioeconomic research in trauma surgery, promoting equity in knowledge dissemination without an impact factor listed due to its open-access model.^[49] The evolution of trauma journals traces back to post-World War II military trauma studies, which influenced civilian medicine by adapting battlefield lessons to urban injury care, with a pivotal milestone in the 1970s being the establishment of organized trauma systems in the United States following the Highway Safety Act of 1966.^[50] This shift spurred dedicated publications to address civilian needs, evolving from ad-hoc military reports to structured peer-reviewed outlets by the mid-20th century.^[51] Most trauma journals are indexed in PubMed/PMC and Scopus, ensuring broad accessibility, with average impact factors ranging from 2 to 4 across the field; open-access models have surged post-2020 to enhance global reach amid rising publication demands.^[52] Key contributions include landmark articles in the 1980s on the standardization of Advanced Trauma Life Support (ATLS) protocols, which appeared in early issues of the Journal of Trauma and established systematic initial assessment for trauma patients.^[53]

Arts, entertainment, and media

Films

Trauma (1993) is an Italian-American giallo horror film directed by Dario Argento.^[54] The plot centers on Aura Petrescu, a young anorexic woman played by Asia Argento, who escapes from a clinic and witnesses the decapitation murders of her parents during a violent storm.^[54] She teams up with David Parsons, a hearing-impaired special effects artist portrayed by Christopher Eccleston, to investigate a serial killer targeting affluent couples and severing their heads with a garrote wire.^[54] The film features a cast including Piper Laurie as Aura's mother, Frederic Forrest, and Brad Dourif, and is noted for its suspenseful atmosphere, elaborate set pieces, and elements of body horror typical of Argento's style.^[54] Produced on a modest budget, it received a limited theatrical release in the United States and Italy, achieving minimal box office returns. Trauma (2004) is a British psychological drama directed by Marc Evans.^[55] The story follows Ben (Colin Firth), an architect who awakens from a coma following a car accident that killed his wife Elisa (Naomie Harris), only to grapple with fragmented memories and hallucinations suggesting he may have witnessed her murder.^[55] As he relocates to a new apartment and begins a tentative relationship with neighbor Lauren (Mena Suvari), Ben's mental state deteriorates amid suspicions of foul play involving a mysterious figure from his past.^[55] The supporting cast includes Kenneth Cranham and Tommy Flanagan, with themes exploring grief, amnesia, and psychological unraveling.^[55] Premiering at the 2004 Sundance Film Festival, it had a limited UK release and earned mixed reviews for its atmospheric tension, though it underperformed commercially.^[56] Trauma (2017) is a Chilean extreme horror film written and directed by Lucio A. Rojas.^[57] The narrative depicts four young friends—Andrea (Catalina Martin), her boyfriend Emilio (Macarena Carrere), and sisters Olivia (Dominga Bofill) and Celeste (Ximena del Solar)—who are terrorized during a weekend getaway in a remote rural house by a sadistic father (Sergio Herrera) and his incestuous son (Ángel Durán).^[57] After enduring brutal home invasion, rape, and torture, the survivors seek justice through violent revenge, drawing on the film's allegorical ties to Chile's history of state-sponsored violence under the Pinochet dictatorship.^[57] Noted for its graphic depictions of sexual violence and unflinching brutality, it stars Gianina García in a supporting role and premiered at the 2017 Amsterdam Fantastic Film Festival before a limited international release.^[57] The production, made on a low budget, achieved cult status in horror circles but had minimal box office success, with earnings primarily from festival circuits and VOD platforms.^[58] Trauma, or Monsters All (2025) is an American independent horror film directed by Larry Fessenden.^[59] Serving as a sequel connecting Fessenden's earlier monster movies—Habit (1997, vampire), Depraved (2019, Frankenstein), and Blackout (2023, werewolf)—the plot intertwines supernatural lore with themes of personal trauma, as the creatures confront their existential regrets and violent pasts in a shared narrative.^[59] Fessenden reprises his role as the vampire Sam, alongside Alex Breaux as the reanimated Adam, Joseph Castillo-Midyett as the werewolf Charley, and new cast members including Barbara Crampton, Aitana Doyle, and Laëtitia Hollard.^[59] Filmed secretly in upstate New York and wrapping production in August 2025, it is set for premiere at late-2025 film festivals, emphasizing indie horror's blend of genre homage and emotional depth.^[59] Films titled Trauma have evolved from the 1990s' focus on psychological thrillers and investigative suspense, as seen in Argento's giallo entry with its limited release and niche appeal, to 2020s revenge and monster hybrids that leverage festival circuits for distribution amid modest box office returns. Psychological trauma motifs often serve as narrative drivers, propelling characters through cycles of investigation, recovery, and retribution across these works.

Television

Trauma is an American medical drama television series that aired on NBC from September 28, 2009, to April 26, 2010. Created by Dario Scardapane, the show follows the high-stakes work and personal lives of a team of paramedics and EMTs from San Francisco's "Response Team 15," who respond to emergencies via helicopter, boat, and ambulance, often dealing with severe physical trauma cases such as electrocutions, shootings, and accidents.^[60]^[61] The series stars Cliff Curtis as team leader Joe Saviano, Derek Luke as Christopher "Rabbit" Gordon, Anastasia Griffith as doctor Vanessa Ridley, and Aimee Garcia as Marisa Bowe, blending intense action sequences with interpersonal drama among the crew.^[60] Over its single season of 18 episodes, storylines explore the emotional toll of rescue operations, including episodes like the pilot where the team handles a rooftop electrocution and cardiac arrest, and "Stuck," focusing on a trapped construction worker, highlighting the procedural elements of emergency response.^[62] The pilot episode drew 6.9 million viewers, but ratings declined, averaging around 5 million, leading to cancellation after one season despite initial buzz for its adrenaline-fueled format.^[63] Critics offered mixed reviews, praising the fast-paced action and character dynamics but criticizing formulaic plots and unrealistic medical depictions, with some outlets noting its entertainment value akin to earlier paramedic shows.^[61]^[64] In contrast, the 2018 British mini-series Trauma, created and written by Mike Bartlett, is a three-part psychological drama broadcast on ITV from February 12 to 14, 2018. Starring John Simm as grieving father Dan Bowker and Adrian Lester as trauma surgeon Jon Allerton, the series centers on Dan's obsession with blaming Jon for his teenage son Alex's death after a car accident, delving into themes of guilt, revenge, and the flaws in the healthcare and legal systems.^[65] The episodes unfold over consecutive nights: the first introduces the accident and immediate aftermath in the hospital trauma unit; the second escalates Dan's harassment of Jon, affecting their families; and the third resolves the confrontation through legal proceedings and emotional reckoning, emphasizing personal trauma over procedural heroics.^[66] Reception was generally positive for its emotional depth and strong performances, with critics highlighting the tense exploration of parental loss, though some found the plot contrived and characters unsympathetic; it holds a 100% critic score on Rotten Tomatoes from a small sample of reviews.^[67]^[66] By 2023, the mini-series became available for international streaming on platforms like BritBox and Amazon Prime Video.^[68] Both productions incorporate trauma as a core motif, with the American series focusing on the adrenaline of physical emergency interventions and the 2018 mini-series on the lingering psychological and relational impacts, influencing portrayals of medical professionals in later dramas through their mix of high-tension scenarios and character-driven narratives.^[61]^[69]

Music

Trauma is an American heavy metal band formed in 1981 in San Francisco, California, specializing in power and speed metal with influences from the Bay Area thrash scene. The band gained early recognition for its high-energy performances and lineup that briefly included future Metallica bassist Cliff Burton before his departure in 1982. After a hiatus in the mid-1980s following the release of their debut album, Trauma reunited in 2013, continuing to tour and record with a focus on aggressive riffs and dynamic song structures. Drummer Kris Gustofson, a mainstay since 1982, has been central to the band's longevity and revival efforts.^[70]^[71]^[72] The band's discography includes the debut album Scratch and Scream (1984), reissued in 2013 with bonus tracks featuring early demos by Cliff Burton, capturing the raw speed metal sound of their formative years. Subsequent releases encompass Rapture and Wrath (2015), blending thrash elements with melodic hooks; As the World Dies (2018), exploring themes of societal decay; and Awakening (2022, Massacre Records), which delves into apocalyptic imagery and human resilience amid chaos through tracks like "Death of the Angel" and "The River Red." Notable songs include the title track "Scratch and Scream," a high-speed thrash anthem showcasing blistering guitar work; "As the World Dies," a critique of modern societal ills with pounding rhythms; and "Walk Away," the 2022 single from Awakening accompanied by an official music video released in July of that year.^[73]^[70]^[74]^[75] Another band sharing the name is the Polish death metal outfit Trauma, formed in 1988 in Elbląg (initially as Thanatos before renaming in 1992), and remains active with a sound rooted in brutal, technical death metal. Their early releases, such as the demo Invisible Reality (1992) and debut full-length Dawn of the End (1993), contributed to the burgeoning Polish extreme metal scene alongside acts like Vader. Later releases include Ominous Black (2020). The band maintains a cult following documented in metal archives for its raw intensity and anti-religious, violent lyrical themes, and continues to perform live, including concerts in 2025.^[76]^[77] The original Scratch and Scream (1984) received praise for its energetic performances and thrash-infused power metal but suffered from limited distribution via the independent Shrapnel Records label, hindering wider commercial success. In contrast, Awakening (2022) was lauded for its polished modern production, incorporating contemporary mixing techniques while retaining the band's classic aggression, and has garnered streaming attention on platforms like Spotify with over 3,000 monthly listeners as of 2025. Lyrics across Trauma's works often reference personal and societal distress, reflecting broader metal tropes of turmoil and defiance.^[73]^[78]^[79]

Sports

Institutes and organizations

The Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), established in 1973 at Lenox Hill Hospital in New York City, was the world's first hospital-based institute dedicated exclusively to sports medicine.^[80] Founded by orthopedic surgeon James A. Nicholas, who served as team physician for the New York Jets, NISMAT emphasizes injury prevention, rehabilitation, and research tailored to athletic populations.^[81] Key programs include the Running Clinic, which addresses overuse injuries in runners through gait analysis and customized training, and the Biomechanics Laboratory, where motion capture technology evaluates joint mechanics to mitigate trauma risks.^[80] Other prominent organizations include STOP Sports Injuries, launched in 2010 by the American Orthopaedic Society for Sports Medicine (AOSSM), which focuses on awareness campaigns to prevent overuse and traumatic injuries in youth athletes via educational resources for parents, coaches, and clinicians.^[82] The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), founded in 1995, advances global research on sports traumatology, particularly for elite athletes, through congresses, consensus statements, and studies on ligament repairs and joint preservation. NISMAT has made significant contributions through publications on anterior cruciate ligament (ACL) tears, including the development of the Lenox Hill derotation brace to stabilize unstable knees, and protocols for managing concussions in contact sports.^[83] It hosts annual events such as the James A. Nicholas Sports Medicine Symposium and provides training for coaches on injury recognition and prevention, with programs continuing into 2025.^[84] Historically, NISMAT pioneered orthopedic sports medicine amid the 1970s athletic participation boom, influencing standards for trauma care in professional leagues; its founder's work with the NFL, including surgeries on quarterback Joe Namath, and advisory roles in Olympic athlete health underscore its enduring impact.^[81]^[85]

Trauma in sports

Trauma in sports encompasses both physical and psychological injuries arising from athletic activities, often resulting from high-impact collisions, repetitive stress, or competitive pressures. From 2011-2015 data, sports and recreation injuries accounted for approximately 30% of emergency department visits among individuals aged 5-24 years in the United States, with nearly 3 million such visits occurring annually among youth; post-COVID-19, overall sports injury rates have risen, with increases of 20% in 2021, 12% in 2022, 2% in 2023, and 17% in 2024.^[86]^[87] Globally, increased youth participation in sports following the COVID-19 pandemic has contributed to a rise in injury rates, driven by resumed training and competition, including notable increases in head and shoulder injuries in activities like hockey.^[88]^[89] Common physical injuries in sports include concussions, anterior cruciate ligament (ACL) tears, and chronic conditions like chronic traumatic encephalopathy (CTE). Concussions, particularly prevalent in contact sports such as football, affect an estimated 1.6 to 3.8 million athletes annually in the US, though recent 2025 CDC surveys indicate dramatically higher prevalence rates than previously estimated.^[90]^[88]^[91] ACL tears frequently occur as non-contact injuries during pivoting maneuvers in soccer, leading to significant knee instability and long-term mobility issues.^[92] CTE, a progressive neurodegenerative disease, develops from repeated head impacts—even subconcussive ones—in sports like football, causing symptoms such as cognitive decline, depression, and dementia later in life.^[93]^[94] Psychological trauma in sports manifests as performance anxiety following injury, burnout from overtraining, and team-wide grief after severe accidents, exacerbating physical recovery challenges. Injured athletes commonly experience post-injury distress, including anxiety and depression, which can prolong rehabilitation and affect return to play.^[95] Studies indicate that 13-25% of athletes develop posttraumatic stress disorder (PTSD) or related trauma disorders after injuries, a rate higher than in the general population, often triggered by the fear of reinjury or loss of identity.^[96] Burnout from excessive training loads contributes to emotional exhaustion and reduced motivation, particularly in high-performance settings.^[97] Prevention strategies focus on rule modifications, targeted conditioning, and early screening to mitigate risks. In the NFL, rule changes in the 2010s, including bans on helmet-to-helmet hits and mandatory helmet testing protocols, have reduced concussion rates by emphasizing safer tackling techniques. The FIFA 11+ program, a structured warm-up routine for soccer, incorporates neuromuscular exercises that have been shown to decrease overall injuries by up to 32% and overuse injuries by 53% in youth and collegiate players.^[98]^[99] Screening tools, such as workload monitoring apps and biomechanical assessments, help identify overuse risks early, preventing conditions like stress fractures in runners and throwers.^[92] Recovery from sports trauma emphasizes phased protocols and multidisciplinary support to ensure safe reintegration. The Graduated Return to Play (GRTP) protocol for concussions, endorsed by the CDC, consists of 6 stages—from symptom-limited rest to full-contact practice—typically spanning 7-10 days or longer, with medical clearance required at each step to avoid second-impact syndrome.^[100]^[101] Sports psychologists play a crucial role in mental rehabilitation, using cognitive-behavioral techniques to address fear of reinjury, rebuild confidence, and manage PTSD symptoms, thereby improving overall adherence to physical therapy.^[95]

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Post-Traumatic Stress Disorder (PTSD)
Past year prevalence of PTSD among adults was higher for females (5.2%) than for males (1.8%). The lifetime prevalence of PTSD was 6.8%.2. Figure 1. Past Year ...Missing: APA | Show results with:APA
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Brain regions that arc altered in patients with PTSD include the hippocampus and amygdala as well as cortical regions including the anterior cingulate, insula, ...
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Traumatic stress: effects on the brain - PMC - PubMed Central - NIH
Lasting effects of trauma on the brain, showing long-term dysregulation of norepinephrine and Cortisol systems, and vulnerable areas of hippocampus, amygdala, ...
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In the immediate aftermath of a major traumatic event, most people complain of stress, difficulty concentrating, sleeping or getting along with others. Usually, ...
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About the Trauma Verification, Review, and Consultation Program
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Resources for Optimal Care of the Injured Patient | ACS
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ACS releases December 2023 revision of trauma standards
Jan 9, 2024 · Standard 4.15 requires Level I and II centers ... Level III trauma center in states where these providers are licensed to practice independently.
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EMS Mass Casualty Triage - StatPearls - NCBI Bookshelf - NIH
Simple triage and rapid treatment (START) is currently the most widely used triage system in the United States for mass casualty incidents.
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START Adult Triage Algorithm - CHEMM
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[PDF] Trauma Activation and Consultation Criteria
Trauma Team Leader: The trauma surgery or emergency department senior resident assigned to lead the care team for the individual patient resuscitation.
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Overview of damage control surgery and resuscitation in patients ...
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Permissive Hypotension - StatPearls - NCBI Bookshelf - NIH
Mar 1, 2024 · Incremental fluid infusions are recommended to raise the MAP above 80 mm Hg in cases of significant cerebral hemorrhagic trauma leading to ...Anatomy and Physiology · Indications · Contraindications · Technique or Treatment
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[PDF] BEST PRACTICES GUIDELINES FOR ACUTE PAIN MANAGEMENT ...
Multimodal Pain Management across the Trauma Care Continuum. Systemic Opioids ... TQIP Palliative Care Guidelines. Key Points: ○ Withdrawal of life ...
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Guidelines for essential trauma care
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Teletrauma Can Improve Access to Care in Rural and Small ...
Feb 11, 2025 · Teletrauma may help alleviate access issues by connecting providers in diverse practice settings with trauma experts.
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Leveraging AI to Meet the New ACS Trauma Center Standards - Viz.ai
Jul 19, 2023 · ACS is expected to begin verification visits to ensure that trauma centers are meeting these standards in September 2023 and many ...<|separator|>
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Medical and trauma care made slow progress during the limited wars of the 19th century, but was greatly challenged by smaller wars in adverse environments. In ...
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Journal of Trauma and Acute Care Surgery
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill ...Current Issue · Previous Issues · Latest Articles · Video Gallery
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Trauma - All Issues - Sage Journals
Trauma · Impact Factor: 0.7 / 5-Year Impact Factor: 0.7 · Journal Homepage ... 2024 · 2025 · Volume 27, Issue 4, October 2025. CURRENT ISSUE. pp. 265-334. Volume ...
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European Journal of Trauma and Emergency Surgery
The European Journal of Trauma and Emergency Surgery is an international English-language journal providing an interdisciplinary forum for the scientific ...Volumes and issues · Aims and scope · Collections and calls for papers · Articles
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About | Scandinavian Journal of Trauma, Resuscitation and ...
... Resuscitation and Emergency Medicine logo Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine ... Journal Impact Factor: 3.1 (2024) 5-year ...
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Trauma Surgery & Acute Care Open: Homepage
TSACO is an open access journal publishing high-quality epidemiological, educational, and socioeconomic research on trauma surgery and critical care.
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The origins of the US Civilian Trauma and Emergency Medical Services Systems (EMSS) started in the 1970s are presented.Missing: milestone | Show results with:milestone
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ACS COT 100 Years: Emergency Medical Services and Trauma ...
Sep 1, 2022 · The most notable milestone is the evolution of emergency medical services (EMS) and the creation of the trauma system itself.
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https://pubmed.ncbi.nlm.nih.gov/20838158/
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Three decades (1978–2008) of Advanced Trauma Life Support ...
The Advanced Trauma Life Support (ATLS) Program was developed to teach doctors one safe, reliable method to assess and initially manage the trauma patient.
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Trauma (1993) - IMDb
Rating 5.8/10 (8,702) A TV newsroom artist (Mark Rydell) helps a distraught anorexic (Asia Argento) to investigate the death of Argento's mother (Piper Laurie) at the hands of a ...Plot · Trauma · Full cast & crew · Asia Argento as Aura Petrescu
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Trauma (2004) - IMDb
Rating 4.7/10 (3,635) Marc Evans directs this superior British made movie about a man who awakens from a coma to discover his wife is dead and he's haunted by images from the past.Plot · Full cast & crew · User reviews · Parents guide
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Trauma - Variety
Jan 26, 2004 · The psychological thriller about a coma patient who emerges into an increasingly delusional world is hampered by narrative incoherence, sluggish pacing and ...Missing: summary cast
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Trauma (2017) - IMDb
Trauma: Directed by Lucio A. Rojas. With Catalina Martin, Macarena Carrere, Dominga Bofill, Ximena del Solar. Four friends, partying in a house in the ...User reviews · Plot · Full cast & crew · Lucio A. Rojas
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Trauma (2017) | Rotten Tomatoes
Discover reviews, ratings, and trailers for Trauma (2017) on Rotten Tomatoes. Stay updated with critic and audience scores today!Missing: production | Show results with:production
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'Trauma': Larry Fessenden's New Film Is a Monster Mash Sequel to ...
Aug 5, 2025 · 'Trauma' writer and director Larry Fessenden made a sequel to three previous monster movies, including 'Habit,' 'Depraved' & 'Blackout.'Missing: premiere | Show results with:premiere
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Mapping movie genre evolution (1994 – 2019) using the role of ...
Jun 13, 2023 · The researchers have thematically analysed the top five revenue grossing movie genres over a span of 26 years (1994 to 2019) in Bollywood.
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Trauma (American TV series) - Wikipedia
Trauma is an American medical drama television series created by Dario Scardapane which was aired on NBC from September 28, 2009 to April 26, 2010.Missing: details creator reviews
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Trauma (TV Series 2009–2010) - IMDb
Rating 7.6/10 (2,798) Follows a small group of flight paramedics on the job and in their lives outside of work. 7.6 /10 2.8K YOUR RATING RateMissing: cancellation | Show results with:cancellation
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Trauma — TV Review - The Hollywood Reporter
Sep 25, 2009 · There's a lot to chew on: Creator-writer Dario Scardapane doesn't underestimate his audience, and by creating bickering leads with enigmatic ...
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Trauma (TV Series 2009–2010) - Episode list - IMDb
S1.E1 ∙ Pilot · S1.E2 ∙ All's Fair · S1.E3 ∙ Bad Day at Work · S1.E4 ∙ Stuck · S1.E5 ∙ Masquerade · S1.E6 ∙ Home Court · S1.E7 ∙ That Fragile Hour · S1.E8 ∙ M'aidez.Missing: NBC | Show results with:NBC
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NBC Picks Up Ratings Troubled 'Trauma' - Deadline
Nov 19, 2009 · On its first airing, the Peter Berg-produced Trauma drew just 6.9 million viewers and a 2.3 rating in the key 18-49 category.
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Trauma TV Review | Common Sense Media
Rating 2.0 · Review by Will WadeOct 24, 2022 · Muddled medical drama is intense but predictable. Read Common Sense Media's Trauma review, age rating, and parents guide.Missing: cancellation | Show results with:cancellation
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Trauma (British TV series) - Wikipedia
Created and written by Mike Bartlett, the series is about a father grappling with losing his son and blaming the trauma consultant.Missing: details streaming
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Trauma (TV Mini Series 2018) - IMDb
Rating 5.9/10 (1,841) A three-part drama set in the trauma unit of a London hospital, a grieving father blames a high-achieving trauma consultant for the death of his teenage son.Missing: reception | Show results with:reception
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Season 1 – Trauma - Rotten Tomatoes
Rating 100% (10) Dan Bowker comes home from work in a drunken state to discover his teenage son hasn't come home and no-one knows where he is; Jon Allerton, a trauma surgeon, is ...Missing: mini- | Show results with:mini-
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Trauma review – presses our noses up against the window of ...
Feb 13, 2018 · I was hoping that Mike Bartlett was going to redeem himself in my eyes. But no: unlikable characters, unbelievable situations, no credibility, ...Missing: reception | Show results with:reception
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Trauma - watch tv show streaming online - JustWatch
Rating 41% (87) Find out how and where to watch "Trauma" online on Netflix, Prime Video, and Disney+ today – including 4K and free options.
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The week in TV: Troy: Fall of a City; Collateral; Trauma and more
Feb 18, 2018 · But it was Mike (Doctor Foster) Bartlett's Trauma that, oddly enough, made the greater impact, being not about high-vaulting Themes but about ...Missing: reception | Show results with:reception
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Trauma - Encyclopaedia Metallum: The Metal Archives
Aug 16, 2002 · Status: Active ; Formed in: 1981 ; Genre: Power/Speed Metal ; Themes: Metal, Society, Life, Death, History ; Current label: Massacre Records.
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Trauma Hits Back With New Album "Awakening" (Interview)
Nov 11, 2022 · The Bay Area power/speed metal band, reformed in 2013 after a hiatus in the mid-1980s, carves a new path with their recent material that's ...
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Trauma (USA) Interview - The Metal Crypt
Nov 15, 2022 · Trauma is a heavy/thrash band from San Francisco, California, formed in 1981. The band released their well-received debut album, Scratch and ...
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Scratch and Scream - Trauma - Shrapnel Records
In 1984, TRAUMA recorded the Scratch And Scream album for Shrapnel Records. The album received many excellent reviews from primarily American and European ...
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Trauma - Encyclopaedia Metallum: The Metal Archives
Oct 7, 2002 · Trauma is a Polish death metal band formed in 1992, with themes of death, serial killers, violence, and anti-religion. They are currently ...
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Trauma - Awakening - Metal Kaoz
Aug 27, 2022 · (CD/LP, Massacre Records, 2022). Everyone knows TRAUMA because of being Cliff Burton's band before he joined METALLICA.
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Trauma | Spotify
Heavy Metal · Trauma: Past and Present. About. 3,158 monthly listeners. TRAUMA is highly revered by those in the know as an important evolutionary entity i …
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AOSSM and NCYS team up to STOP Sports Injuries
Feb 28, 2022 · AOSSM has made a generous financial donation to NCYS to support the STOP (Sports Trauma and Overuse Prevention) Sports Injuries program.
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NISMAT Physical Therapy Publications
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[PDF] Injury Prevention
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Dr. James A Nicholas
Since its inception in 1973, NISMAT has been, through its research, a major contributor to sports medicine and its allied disciplines, including physiology, ...
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Sports Cause Nearly 3 Million ER Visits Each Year
Nov 15, 2019 · Nearly 3 million emergency department visits every year are caused by youth sports, according to new federal estimates.Missing: epidemiology CDC concussions 3.8 yearly, global post- 2020
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Aug 26, 2024 · CDC collects and reports data on sports- and recreation-related TBIs and concussions to understand how many people are affected, who is most at risk.Missing: 5-24 3.8 million global post-
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CTE is a distinctive neurodegenerative disease that occurs as a result of repetitive head impacts (RHI) including concussion and subconcussion.
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The Effect of the FIFA 11+ on Injury Prevention and Performance in ...
Aug 10, 2022 · The total number of injuries was 36 for the FIFA 11+ players, in which 34 of them were caused by acute trauma and 2 were caused by overuse. Most ...
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Effect of the FIFA 11+ injury prevention program in collegiate female ...
Multicomponent IPT programs like the FIFA 11+ have demonstrated preventive effects, reducing overall injuries by 32%, overuse injuries by 53%, and severe ...
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Sep 15, 2025 · After a concussion, an athlete should only return to sports practices with the approval and under the supervision of their healthcare provider.
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What Every Coach Needs to Know About the Concussion Return to ...
The Step-by-Step Return-to-Play Protocol · Stage 1: Symptom-Limited Activity · Stage 2: Light Aerobic Exercise · Stage 3: Sport-Specific Exercise · Stage 4: Non- ...Missing: rehab | Show results with:rehab