Abstract
BackgroundAmong trauma patients relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. To identify opportunities for prevention and early treatment, predictors and course of PTSD need to be investigated. Long-term follow-up studies of injury patients may help gain more insight into the course of PTSD and subgroups at risk for PTSD. The aim of our long-term prospective cohort study was to assess the prevalence rate and predictors, including pre-hospital trauma care (assistance of physician staffed Emergency Medical Services (EMS) at the scene of the accident), of probable PTSD in a sample of major trauma patients at one and two years after injury. The second aim was to assess the long-term course of probable PTSD following injury.MethodsA prospective cohort study was conducted of 332 major trauma patients with an Injury Severity Score (ISS) of 16 or higher. We used data from the hospital trauma registry and self-assessment surveys that included the Impact of Event Scale (IES) to measure probable PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of probable PTSD.ResultsOne year after injury measurements of 226 major trauma patients were obtained (response rate 68%). Of these patients 23% had an IES-score of 35 or higher, indicating probable PTSD. At two years after trauma the prevalence rate of probable PTSD was 20%. Female gender and co-morbid disease were strong predictors of probable PTSD one year following injury, whereas minor to moderate head injury and injury of the extremities (AIS less than 3) were strong predictors of this disorder at two year follow-up. Of the patients with probable PTSD at one year follow-up 79% had persistent PTSD symptoms a year later.ConclusionsUp to two years after injury probable PTSD is highly prevalent in a population of patients with major trauma. The majority of patients suffered from prolonged effects of PTSD, underlining the importance of prevention, early detection, and treatment of injury-related PTSD.
Highlights
Among trauma patients relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found
Study population During the study period of 30 months, 524 major trauma patients were admitted to the Emergency Department of the study hospital, of which 162 (31%) patients died within 30 days after hospital admission
Of the remaining 362 survivors, 332 were aged 16 years or older. These patients were included in the prospective cohort study on PTSD
Summary
Among trauma patients relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. The aim of our long-term prospective cohort study was to assess the prevalence rate and predictors, including pre-hospital trauma care (assistance of physician staffed Emergency Medical Services (EMS) at the scene of the accident), of probable PTSD in a sample of major trauma patients at one and two years after injury. The second aim was to assess the long-term course of probable PTSD following injury. Trauma patients have relatively high prevalence rates of PTSD; prevalence rates up to 39% have been found one to four months after the injury [8]. At long-term follow-up (>1 year) PTSD prevalence rates vary from 5% among traffic injury victims [9] to 32% among major trauma patients [10]
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