Abstract
BackgroundAs many as 12% of acute coronary syndrome (ACS) patients screen positive for post-traumatic stress disorder (PTSD) symptoms due to their cardiac event, and emergency department (ED) factors such as overcrowding have been associated with risk for PTSD. We tested the association of patients’ perceptions of their proximity to a critically ill patient during ED evaluation for ACS with development of posttraumatic stress symptoms (PSS) in the month after hospital discharge.MethodsParticipants were enrolled in the REactions to Acute Care and Hospitalization (REACH) study during evaluation for ACS in an urban ED. Participants reported whether they perceived a patient near them was close to death. They also reported their current fear, concern they may die, perceived control, and feelings of vulnerability on an Emergency Room Perceptions questionnaire. One month later, participants reported on PTSD symptoms specific to the cardiac event and ED hospitalization.ResultsOf 763 participants, 12% reported perceiving a nearby patient was likely to die. In a multivariate linear regression model [F(9757) = 19.69, p < .001, R2 adjusted = .18] with adjustment for age, sex, GRACE cardiac risk score, discharge ACS diagnosis, Charlson comorbidity index, objective ED crowding, and depression symptoms at baseline, perception of a nearby patients’ likely death was associated with a 2.33 point (95% CI, 0.60–4.61) increase in 1 month PTSD score. A post hoc mediation analysis with personal threat perceptions [F(10,756) = 25.28, p < .001, R2 adjusted = .24] showed increased personal threat perceptions during the ED visit, B = 0.71 points on the PCL per point on the personal threat perception questionnaire, β = 0.27, p = .001, fully mediated association of participants’ perceptions of nearby patients’ likely death with 1-month PTSD score (after adjustment for ED threat perceptions,) B = 0.89 (95% CI, −1.33 to 3.12), β = 0.03, p = .43, accounting for 62% of the adjusted effect and causing the main effect to become statistically nonsignificant.ConclusionsWe found patients who perceived a nearby patient was likely to die had significantly greater PTSD symptoms at 1 month. Awareness of this association may be helpful for designing ED patient management procedures to identify and treat patients with an eye to post-ACS psychological care.
Highlights
As many as 12% of acute coronary syndrome (ACS) patients screen positive for post-traumatic stress disorder (PTSD) symptoms due to their cardiac event, and emergency department (ED) factors such as overcrowding have been associated with risk for PTSD
Participants were 763 patients being evaluated for acute coronary syndrome in the ED
We found that 12% of participants who recalled being near a patient that was likely to die did not endorse that item during ED enrollment
Summary
Data collection procedures and measures used in the Reactions to Acute Care and Hospitalization (REACH) study are summarized in brief below. Nearby patients item During the ED enrollment interview, participants reported on their perceptions of mortality risk in proximal patients: “Does it seem like another patient in the emergency room may die?” on a Likert scale (0, not at all, to 3, extremely). Once we chose the most valid assessment of participants’ perception of proximity to another patient who was likely to die, we tested the association of that variable with PTSD symptoms at 1 month. We tested a multivariate linear regression model with PTSD score as the dependent variable, and the dichotomous variable for perception that a nearby patient may die as the primary predictor variable. In a posthoc mediation analysis, we tested whether greater participant personal threat perceptions (i.e., perceptions of personal fear, lack of control, vulnerability, and mortality risk) accounted for the association of perceiving critical illness/mortality risk in nearby patients with subsequent PTSD symptoms. Log transformation partially normalized the PCL distribution, but results did not differ substantially when we replaced the PCL with the transformed PCL score as the dependent variable, so results are reported in the original metric to aid interpretation
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