427 Prevalence and Risk Factors for Posttraumatic Stress Disorder after Burn Injury

Abstract

After burn injury, patients can struggle psychologically in addition to issues with physical function and cosmesis. Posttraumatic stress disorder (PTSD) is a known sequela of burn injury, with a suggested frequency of 18-33%. However objective measures of injury have not been reliably linked to the development of symptoms, making routine identification a challenge. The objective of this study to identify patient characteristics associated with a positive PTSD screening exam in the outpatient setting. The Primary Care Posttraumatic Stress Disorder screening questionnaire (PC-PTSD-4) was administered to patients at their initial outpatient clinic visit at a large regional Burn Center over a four month period of May-October 2018. Patients excluded included those with dermatologic disorders, known history of PTSD and repeat questionnaires. Patient demographics, injury mechanism, total body surface area (TBSA) involvement and questionnaire results were recorded. Patients were considered screen positive if they responded affirmatively to at least three of the four questions. Chi-square and student’s t-tests were used to compare patients with positive and negative screens. Further evaluation assessed the sub-population that answered affirmatively to all four screening questions. 188 surveys were answered in total, with 182 remaining for analysis after exclusions. Patients had a mean age of 41.8±15.5 years, mean TBSA of 4.5±7.5%, with equal gender distribution. 6.6% of questionnaires were completed in Spanish. The most common injury etiologies included scald (24.2%), flame (24.2%) and grease burns (20.3%). Positive screens were noted in 48 patients (26.4%), with 30 of these patients responding affirmatively to all four questions, and 83 with negative responses to all questions. The only significant predictor for a positive screen was increased total TBSA% (4.0±5.6 vs 6.0±11.2, p = 0.004). A similar finding was noted when examining patients with four affirmative responses (p < 0.001). Although all patients are susceptible to PTSD after burn injury, positive screening correlates with larger initial injury. Future directions of this project will evaluate additional factors including concurrent traumatic injuries, prior psychiatric history and the presence of assault. Early identification of at-risk individuals enables expedited efforts to provide education and support.