Abstract
BackgroundThe 82.1% treatment failure of post-traumatic stress disorder (PTSD), associated with gunshot wounds, is related to high incidence of chronic pain syndrome as well as resistance to the PTSD treatment. Defining treatment failure predictors among the PTSD patients with gunshot extremity wounds and the following therapy would improve treatment outcomes.MethodsA total of 218 patients completed the study. The Mississippi Scale for Combat-Related PTSD (M-PTSD) was used for assessment of the treatment outcome rate. The risk relation between treatment failure and factors was assessed by a univariate or multivariate logistic regression method, with the model accuracy measured by the AUC – Area under the ROC curve. The odds ratio (OR) was considered for the qualitative factor assessment.ResultsThe predictors of the PTSD treatment failure among the patients with gunshot wounds to the extremities are: 1) anesthesia type: the risk of failure is higher with the general anesthesia compared to the regional (p = 0.002), OR = 0.30 (95% CI 0.13-0.69) and the regional one with sedation (p = 0.004), OR = 0.30 (95% CI 0,14-0.65); 2) severe postoperative pain: the risk of treatment failure rises with increased pain intensity assessed by the visual analogue scale (p = 0.02), OR = 3.2 (95% CI 1.2-8.3).ConclusionsThe analysis showed that administration of general anesthesia compared to the regional one (regardless of the sedation) and high postoperative pain intensity are associated with higher risk of the PTSD treatment failure among patients with gunshot wounds to the extremities. The preference of regional anesthesia and postoperative pain control may potentially improve the treatment outcomes.Trial registrationClinicalTrials.gov: Retrospectively registered on December 30, 2020, NCT04689022.
Highlights
The 82.1% treatment failure of post-traumatic stress disorder (PTSD), associated with gunshot wounds, is related to high incidence of chronic pain syndrome as well as resistance to the PTSD treatment
The study is based on the authors’ clinical experience of treatment of 218 combatants with gunshot wounds to the extremities, accompanied with the PTSD, during 2014-2019, the patients operated under anesthesia
The treatment outcome rate was assessed by the Mississippi Scale for Combat-Related PTSD (M-PTSD)
Summary
The 82.1% treatment failure of post-traumatic stress disorder (PTSD), associated with gunshot wounds, is related to high incidence of chronic pain syndrome as well as resistance to the PTSD treatment. Defining treatment failure predictors among the PTSD patients with gunshot extremity wounds and the following therapy would improve treatment outcomes. War is a strong psycho-social factor affecting all society layers [11], and, first of all, military combatants [9, 12]. The crisis, which they have experienced, predisposes for the PTSD development [1, 4, 7]. According to the Armed Forces of Ukraine Medical Command, the gunshot wounds are represented as follows: 64% of extremity injuries are represented with. The bone defects are noted in 11.6% of the patients, and 35-40% of the patients need subsequent reconstructive interventions
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