Severity Of Physical Injury Research Articles

ANALYSIS OF COMPLAINTS OF VICTIMS DUE TO DOMESTIC VIOLENCE THROUGHOUT 2018-2023, ACCORDING TO THE ARCHIVED DATA OF THE REGIONAL BUREAU OF FORENSIC MEDICAL EXAMINATION OF THE ZHYTOMYR REGIONAL COUNCIL

The results of a statistical analysis of the appeals of victims of domestic violence during 2018-2023 according to archival data of the of the regional bureau of forensic medical examination of the Zhytomyr Regional Council are presented.
 Aim of the work. To analyze the appeals of victims of domestic violence during the years 2018-2023 based on archival data of the regional bureau of forensic medical examination of the Zhytomyr Regional Council.
 Materials and methods. The work used archival material of the regional bureau of forensic medical examination of the Zhytomyr Regional Council, which related to the appeals of victims of domestic violence during 2018 – the first quarter of 2023. The obtained quantitative data were processed by methods of variational statistics.
 Results. Statistical processing of archival material of the regional bureau of forensic medical examination of the Zhytomyr Regional Council for the years 2018-2023 revealed 1,328 appeals by women regarding bodily injuries caused in the family and 10 cases of appeals regarding adult molestation of children. It should be noted that during the acute respiratory disease of COVID-19 in 2020-2022 the trend of the number of appeals by women – remained constant and even increased somewhat, and during the Russian military aggression during 2022 and the first quarter of 2023 – the number of appeals almost halved. During 2018-2022 there were manifestations of family violence in the form of child molestation by adults, and in all cases it was the father of the victims.
 Conclusions. Analysis of appeals by victims of domestic violence during 2018-2023 according to archival data of the regional bureau of forensic medical examination of the Zhytomyr Regional Council revealed that: 1) by age, the most appeals were made by women aged 25-44; 2) in terms of the degree of severity of physical injuries, mild and mild injuries with a short-term health disorder, the physical manifestations of which were cuts, bruises, were dominant.

EMERG-ing data: Multi-city surveillance of workplace violence against EMS responders

Problem: Between 1980 and 2021, emergency medical services (EMS) calls experienced a 421% increase, while calls for fires declined by 55%. The more exposure, the more the opportunity for workplace violence (WPV). Due to the non– existence of a reporting system that captures physical and verbal violence, it has been difficult to quantify the degree of WPV experienced by the U.S. fire and rescue service. Methods: To describe WPV in three large metropolitan fire departments, an existing data system was modified. The EMERG platform was selected because it is one of the most confidential data systems available to collect exposures. Results: In a one-year pilot of EMERG, 126 events were reported. Verbal violence was present in 81% of all reports, with physical violence only at 19%. Patients were the most frequently reported assailant (73%).The most frequently reported injury was emotional stress (70%). Six percent of all injuries reported moderate-to-major physical injury severity, and 30% reported moderate-to-major mental injury severity. Discussion: Verbal violence as a contributor to first responder stress is often underestimated. This pilot shows that it can and should be captured. That mental injury severity was consistently rated higher than physical injury severity across all injuries is not surprising given the prevalence of verbal violence reported and because physical violence has emotional sequela. Summary: Data from the EMERG reporting system give us evidence, on a larger scale than has ever existed for the fire and rescue service, that verbal and physical violence, and the resultant emotional stress and mental injury severity, is an issue that needs further attention and resources. Practical Applications: In order to ensure robust surveillance, it remains likely that triangulation of multiple data sources will still be required to approximate the true burden.

Сlosed chest injury with preservation of the integrity of the ribs in the forensic medical assessment of its severity

The Aim. the forensic determination of the severity of closed chest injuries with intact ribs in victims hospitalized in a specialized surgical hospital to establish diagnostic expert criteria for expert assessment of such dmages.Materials and methods. 52 case histories of patients hospitalized hospitalized at the Kharkiv institute of general and emergency surgery named after V.T. Zaitseva were analyzed. Patients were divided into 4 groups based on the dynamics of morpho-functional pathological changes of the injured organs, the final results of the injury, and the presence of life-threatening phenomena.Results. The analysis of observations showed that the main traumatic factor in the emergence of the studied cases is the impact mechanism of blunt solid objects on the chest. Patients with closed blunt chest trauma were divided into observation groups depending on the morphology of the injuries received. The following main variants of the received injury are distinguished: without a contusion and bruised chest and the presence of intrapleural injuries and complications, a chest contusion without complications. Severe injuries were estimated in 15.4% of cases of acute respiratory failure and cases of trauma of partial or complete lung loss. Injuries of medium severity were established in 26.9% of cases of trauma in the absence of danger to life. Minor injuries were established in 57.7% of cases of trauma in the presence of intrapleural injuries and complications or minor injuries without any complications.Conclusions. When forensically determining the degree of severity of closed injuries of the chest, it is necessary to evaluate the morphology of the injury and clinic functional manifestations of life-threatening phenomena. At the same time, diagnostic signs which must be used when determining the severity of physical injuries are the following: the presence of clinical and functional signs of acute respiratory failure, loss of part or all of the respiratory organ (lungs), dynamics and duration of recovery of post-traumatic morpho-functional changes injured organs.

Persons injured in the 2011 terror attacks in Norway - Relationship between post-traumatic stress symptoms, emotional distress, fatigue, sleep, and pain outcomes, and medical and psychosocial factors

Purpose: The main aim was to assess long-term post-traumatic stress symptoms, emotional distress, fatigue, sleep disturbances and pain in individuals hospitalized with physical injuries after two terror attacks in Oslo in 2011, approximately three years after the events. A secondary aim was to explore the relationship between these outcomes and medical and psychosocial factors.Materials and methods: Thirty of 43 potential persons participated. Injury characteristics were collected from medical charts. Level of post-traumatic stress, emotional distress, fatigue, sleep disturbances and pain was assessed and the association with injury severity, resilience, optimism, neuroticism and extroversion, and perceived access to social support was explored.Results: Nine of 30 met criteria for full or partial PTSD, and 14 of 30 displayed clinical levels of emotional distress. Fifteen reported moderate to severe fatigue, and 16 said sleep disturbances affected their daily life. Twelve indicated that pain affected daily activities and work ability, and 15 that pain affected their quality of life. I Resilience, optimism, neuroticism, and perceived social support, were associated with outcomes, but injury severity was not. When controlling for pain, many of the psychosocial variables failed to reach significance.Conclusions: Injury severity was not associated with outcomes. On the other hand, psychosocial factors were, but seemed to be influenced by pain.Implications for rehabilitationPersons who have obtained physical injuries under extreme psychological conditions such as terror, are at high risk of poor long-term outcomes, and will often be in need of comprehensive interdisciplinary rehabilitation services.Psychological outcomes are not associated with severity of physical injury, but premorbid and current psychological variables such as resilience, optimism, personality, and access to social support are highly associated with long-term outcome.Longstanding pain seems to diminish or weaken the role of protective psychological factors and should be addressed in the rehabilitation context.

Motor Vehicle Collisions and Their Consequences—Part II: Predictors of Impairment and Disability

A significant number of persons involved in motor vehicle collisions (MVCs) evidence persistent changes in physical, psychosocial, and cognitive functioning consequent to physical injury. While post-injury impairment and disability can sometimes be predicted with knowledge of injury type and injury severity, post-injury experiences of pain, psychological distress, cognitive dysfunction, and role disruption have been determined to contribute to injury-related impairment and disability. This article represents the second part of a two-part review of MVCs and their consequences. In part I of the review, research findings related to physical, psychosocial, and cognitive changes that occur consequent to injury-causing MVCs are described. In this article, measures used to document the severity of physical injuries are reviewed, along with the most widely accepted definitions of impairment and disability. Models that have been proposed to explain the progression from injury to impairment and disability are reviewed, including a more recently proposed model created specifically to guide the assessment and management of MVC-related outcomes. The greater part of this article is devoted to the review of findings related to physical, psychological, and cognitive predictors of post-MVC impairment and disability. The relation of these predictors to post-MVC impairment and disability is described across three specific injury contexts: (1) whiplash-associated disorders, (2) traumatic brain injury, and (3) polytrauma. In each context, findings related to recovery of function in the form of return to work are summarized, along with findings related to the contribution of compensation to injury-related symptoms and impairments. Although not characterized as a physical injury, chronic pain serves frequently as the post-injury symptom that persists beyond all injury management and rehabilitation efforts and that contributes significantly to MVC-related functional impairment, disability, and emotional distress. It is appropriate, therefore, to include in this review a discussion of those MVC studies that specifically address impairment and disability occurring in relation to chronic pain. The article ends with the identification of ongoing research challenges and future directions for both the study of MVCs and their associated sequelae and clinical practice with persons who are experiencing the consequences of MVC-related injuries.

Victimization Characteristics and Severity of Physical Injury by Domestic Violence

Victimization Characteristics and Severity of Physical Injury by Domestic Violence

The influences of cognitive appraisal, physical injury, coping strategy, and forgiveness of others on PTSD symptoms in traffic accidents using hierarchical linear modeling.

The purpose of this study was to identify how physical injury, perceived threat, forgiveness of others, and problem-focused coping influence the change of posttraumatic stress disorder (PTSD) symptoms. One hundred twenty patients who had experienced a traumatic vehicle accident participated in 1 to 2 months after the accident; 70 of these people involved at 6 months after the accident. We used a hierarchical linear model analysis to verify the impacts of predictors on change of PTSD symptoms as time passed. The results showed that PTSD symptoms decreased over time, and greater perceived threat would worsen PTSD symptoms and more forgiveness would decrease PTSD symptoms. On the other hand problem-focused coping and physical injury severity were not significantly related to the PTSD symptoms. Specifically, greater perceived threat was found to be related with a deceleration of the decrease in PTSD symptoms, whereas greater forgiveness of others was associated with an acceleration of this decrease. However, problem-focused coping and physical injury severity had no influence on the change rate of PTSD symptoms. Cognitive variable could be more important than physical injury to understand PTSD. In addition, forgiveness of other in a traumatic situation needs to be considered as one of coping strategies.

Forensic mental health evaluations of military personnel with traumatic life event, in a university hospital in Ankara, Turkey

IntroductionThe definition of psychological trauma has been rephrased with the DSM-5. From now on, witnessing someone else's traumatic event is also accepted as a traumatic life event. Therefore, the psychiatric examination of forensic cases gains importance for not overlooking a psychiatric trauma. This research aims to discuss the psychiatric examinations of military personnel who had a traumatic life event and to reveal psychiatric states of soldiers after trauma. Materials and methodsThe forensic reports prepared at Gulhane Military Medical Academy (GMMA), Forensic Medicine polyclinic between January 1, 2011 and November 30, 2014 were examined, and among them the cases sent to GMMA Psychiatry polyclinic for psychiatric examination were analyzed retrospectively. ResultsThere were a total of 2408 cases who applied for the arrangement of a judicial report and 167 of them required a psychological examination. Among 167 cases, 165 were male and 2 were female, and the mean age was 25.6 years. Anxiety disorder (53.9%) was the most common diagnosis as a result of the psychiatric examination, following posttraumatic stress disorder (PTSD) (18.6%), and 3.6% had no psychopathology. It was determined that injuries caused by firearms (38.3%) and explosive materials (26.3%) had caused psychological trauma the most. On the other hand, 11 (6.6%) cases were determined to have undergone a psychological trauma on account of being a witness to their friends' injuries during the conflict without experiencing any physical injury. There were not any statistically significant relationships between the severity of physical injury and being PTSD or anxiety disorder. DiscussionDevelopment of PTSD risk is directly correlated with the nature of trauma. The trauma types of the cases in our study were in the high-risk group because of the military population. Our study is of importance in terms of putting forward the psychiatric disorders seen in the military population with traumatic life history associated with war (combat-related). In this research, 26.1% of the cases followed up due to combat-related trauma were diagnosed with PTSD. Interestingly, this ratio was lower than the studies that have larger case numbers. There is still the need to conduct studies that will involve larger participants.

Noneconomic damages due to physical and sexual assault: estimates from civil jury awards

This paper presents a detailed study of jury awards for compensatory damages to victims of crime. Such awards typically result when victims sue third parties who are responsible for some form of negligence such as inadequate security or alcohol over-service. We obtained nationwide data on jury awards to crime victims and examined the relationship between physical losses, medical costs, offender and victim characteristics, and the ultimate compensatory jury award. Despite the large variability in jury awards, we were able to explain 45%-50% of the variation in the natural log of jury awards for physical assault. The awards systematically vary with the severity of physical injuries sustained by the victim. Considerably more variation is found in the case of sexual assault. We use our regressions to construct estimates of noneconomic damages – the pain, suffering and reduced quality of life endured by the average victim of violent crime in the U.S.

Adverse event and error of unexpected life-threatening events within 24 hours of ED admission

ObjectivesErrors and adverse events associated with unexpected life-threatening events including unplanned transfer to the intensive care unit (ICU) and unexpected death after emergency department (ED) hospitalization are not well characterized. We performed this study to investigate the role of unexpected life-threatening events as a trigger to capture errors and adverse events for ED patient safety. MethodsThis prospective observational study enrolled adult non-trauma patients with unexpected life-threatening events within 24h of general ward admission from the ED of a medical center in Taiwan. The period of study was one year (in 2013); the medical records of enrolled patients were reviewed to identify adverse events and errors. We measured the incidence rate of adverse events or errors. Preventability, type, and physical injury severity of adverse events were investigated. ResultsOf 33,224 adult non-trauma ward admissions from the ED, 100 admissions (0.3%) met the study criteria. Incidence rate was 2% and 15% for errors and adverse events, respectively. In admissions involving error, all were preventable and the error type was overlooked of severity. In admissions that involved adverse events, 93.3% were preventable. There were 20% of admissions that resulted in death and 60% developed with severe physical injury. The adverse event types were diagnosis issues (53.3%), management issues (40%), and medication adverse events (6.7%). ConclusionsUnexpected life-threatening events within 24h of admission from the ED could be a useful trigger tool to identify preventable adverse events with serious physical injury in ED.

The Mediating Effect of Perceived Social Acknowledgment on the Relationship Between Patient Assaults and Posttraumatic Stress Reactions in Emergency Nurses.

This study explored whether posttraumatic stress symptoms resulted from workplace assaults were mediated by the perception of social acknowledgment by the victim. A sample of 444 emergency room nurses in China completed questionnaires measuring the frequency and types of patient assaults, the severity of physical injury, the perception of social acknowledgment, and the posttraumatic stress symptoms. Cross-sectional design, multiregression, and bootstrapping mediation analyses were used to test the hypotheses. Results showed that general disapproval and family disapproval mediated the relationship between the frequency of patient assaults and the severity of posttraumatic stress symptoms. These two factors also mediated the links between the injury severity of patient assaults and the development of posttraumatic stress symptoms. Implications for clinical practice and future research were discussed.

Patients' perspectives on the role of their complaints in the regulatory process.

Governments in several countries are facing problems concerning the accountability of regulators in health care. Questions have been raised about how patients' complaints should be valued in the regulatory process. However, it is not known what patients who made complaints expect to achieve in the process of health-care quality regulation. To assess expectations and experiences of patients who complained to the regulator. Interviews were conducted with 11 people, and a questionnaire was submitted to 343 people who complained to the Dutch Health-care Inspectorate. The Inspectorate handled 92 of those complaints. This decision was based on the idea that the Inspectorate should only deal with complaints that relate to 'structural and severe' problems. The response rate was 54%. Self-reported severity of physical injury of complaints that were not handled was significantly lower than of complaints that were. Most respondents felt that their complaint indicated a structural and severe problem that the Inspectorate should act upon. The desire for penalties or personal satisfaction played a lesser role. Only a minority felt that their complaint had led to improvements in health-care quality. Patients and the regulator share a common goal: improving health-care quality. However, patients' perceptions of the complaints' relevance differ from the regulator's perceptions. Regulators should favour more responsive approaches, going beyond assessing against exclusively clinical standards to identify the range of social problems associated with complaints about health care. Long-term learning commitment through public participation mechanisms can enhance accountability and improve the detection of problems in health care.

The Quantitative Minor Injury Scale: Pilot Study of a Scale to Measure Level of Minor Injury after Motor Vehicle Collisions

Study objective: Severity of physical injury after motor vehicle collisions (MVC) may associate with survivors’ mental health; however the quantitative relationship is poorly understood. This is partly because existing injury scales are only sensitive in the potentially fatal range, while most MVC injuries are minor. To quantitatively describe a minor injury, a Quantitative Minor Injury Scale (QMIS) was developed based on injury symptoms, medication, imaging examination, age and hospital stay. Methods: We developed the QMIS after analyzing existing injury and trauma scales coupled with input from Emergency physicians. We recruited 32 MVC survivors with minor injury (rated 1-2 on Abbreviated Injury Scale) who visited the emergency department (ED) within 48 hours of the accident. Depression symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D) within 3 weeks of the trauma and their injuries were quantified with the QMIS. Results: Application of the QMIS in the MVC survivors produced a gradient from 0.6 to 7.8 with an average of 2.65. A significant correlation (R=0.366; p=0.039; n=32) was found with the QMIS score and depression symptoms as measured by the CES-D. Conclusion: Results suggest the QMIS creates differentiation among a population of minor injury patients and may be useful in examining the relationship between minor injury and psychological conditions. The further development of QMIS may generalize the usage of this scale to minor injuries caused by other types of trauma.

Mediating effects of forgiveness and emotion‐focused coping on post‐traumatic stress disorder symptoms caused by physical injury and perceived threat

The purpose of this study was to develop and test a model (including cognitive appraisal, coping strategy, and forgiveness variables) predicting post-traumatic stress disorder (PTSD) in 127 adults who were involved in traffic accidents. Participants were recruited from the inpatient and outpatient departments of three urban hospitals in South Korea. We utilized the path analysis to identify the best fitting model to our data. Path analysis showed that the baseline model compared with an alternative model was more appropriate for our data. Our results indicated that the severity of physical injury was directly related to the participants' perceived threat. The perceived threat had direct and indirect effects on PTSD symptoms through forgiveness and emotion-focused coping strategies. One of the significant findings was that victims' forgiveness of the person at fault for the accident reduced their PTSD symptoms. The severity of physical injury was not related directly to PTSD symptoms. Our study demonstrates that victim's forgiveness of the person at fault in a traumatic situation can be useful in helping their recovery after trauma and the forgiveness process may be applied to traffic accident situations as well as other types of interpersonal trauma.

Posttraumatic Stress Disorder in Hospitalized Terrorist Bombing Attack Victims

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that results from exposure to a traumatic event and consists of intrusive and unwanted recollections; avoidance followed by emotional withdrawal; and heightened physiologic arousal. Hospitalized victims of suicide bombing attacks (SBAs) are unique because of the circumstances and severity of their injuries, which could affect the occurrence and delay the recognition of PTSD. Our objectives were to evaluate the prevalence and severity of PTSD among hospitalized SBA victims and to assess variables of physical injury as risk factors for the development of PTSD. Forty-six hospitalized SBA victims were evaluated for PTSD using the PTSD symptom scale self-report questionnaire by phone. Demographic and medical data regarding the severity and type of injury and medical treatment were collected from medical files. Injury Severity Score was used to assess severity of physical injury. Twenty-four of 46 (52.2%) hospitalized SBA victims developed PTSD. Presence of blast lung injury was significantly higher in the PTSD group compared with the non-PTSD group (37.5% versus 9.1%, respectively; p < 0.04). There was no significant difference in Injury Severity Score between PTSD and non-PTSD groups. Blast lung injury and intracranial injury were found to be positive predictors of PTSD (odds ratio, 125 and 25, respectively). No correlation was found between the length of stay, length of intensive care unit stay, or severity of physical injuries and the severity of PTSD. Hospitalized victims of SBA are considerably vulnerable to develop PTSD. Victims should be monitored closely and treated in conjunction with their physical treatment. Blast lung injury and intracranial injury are predictors of PTSD.

(A175) Traffic Injury Severity Prediction by Algorithm of Automatic Crash Notification System

IntroductionSince 2009 automatic crash notification system(ACNS) using event data recorder(EDR) and mobile communication have been developed for early detection of traffic accident and prediction of physical injury of victims for increase of survival rate via early medical treatment. For adequate prediction of injury, authors developed the guideline and algorithm from parameters related to accident and medical situation. Methods: Expert survey was done about the adequate parameters related to accident and medical situation. Medical record of traffic accident admission was analyzed in a trauma center of a university hospital in Seoul, Korea. Additionally epidemiology of traffic accident death in a region was done. Afterwards data of medical record was linked to data of traffic accident insurance companies.ResultsThe important parameters for prediction of physical injury of victims were as follows: Intercept, deltav, belt, age, intrus, sex, multiple, roll, ejection, narrow, height, weight, steering defect, track loc.ConclusionsPrediction of physical injury severity of victims on traffic accident spot and immediate transfer of related information to adequate medical institution by automatic mobile communication can help the traffic accident victims and upgrade the trauma care system of traffic accident.

Comparative multibody dynamics analysis of falls from playground climbing frames

This paper shows the utility of multibody dynamics in evaluating changes in injury related parameters of the head and lower limbs of children following falls from playground climbing frames. A particular fall case was used as a starting point to analyze the influence of surface properties, posture of the body at impact, and intermediate collisions against the climbing frame before impacting the ground. Simulations were made using the 6-year-old pedestrian MADYMO rigid body model and scaled head contact characteristics. Energy absorbing surfaces were shown to reduce injury severity parameters by up to 30–80% of those of rigid surfaces, depending on impact posture and surface. Collisions against components of a climbing frame during a fall can increase injury severity of the final impact of the head with the ground by more than 90%. Negligible changes are associated with lower limb injury risks when different surfacing materials are used. Computer reconstructions of actual falls that are intended to quantify the severity of physical injuries rely on accurate knowledge of initial conditions prior to falling, intermediate kinematics of the fall and the orientation of the body when it impacts against the ground. Multibody modelling proved to be a valuable tool to analyze the quality of eyewitness information and analyze the relative injury risk associated with changes in components influencing fall injuries from playground climbing frames. Such simulations can also support forensic investigations by evaluating alternative hypotheses for the sequence of kinematic motion of falls which result in known injuries.

AN ASSESSMENT OF INJURY TO EUROPEAN BADGERS (MELES MELES) DUE TO CAPTURE IN STOPPED RESTRAINTS

As part of ongoing culling operations, European badgers (Meles meles) were captured using stopped restraints in winter (October to December 2005) and summer (May to June 2006) in the Republic of Ireland. A subset of these badgers, those caught during four consecutive nights, was examined postmortem to determine the frequency and severity of physical injuries resulting from capture in the restraints. The skin and the tissues underlying the restraint of 343 badgers were assessed for injury by visual examination. There was an absence of skin damage or only minor skin abrasions in 88% of badgers; an absence of subcutaneous tissue injury or only localized subcutaneous tissue injury in 69%; and an absence of muscle injury or only slight muscle bruising in 99% of badgers. Only 2% of badgers had cuts to the skin and 5.5% had extensive subcutaneous edema, whereas 1.2% had areas of hemorrhage and tearing of the underlying muscle. Our results show that the majority of badgers examined sustained minimal injuries attributable to capture in stopped restraints.

Injured Soldiers' Symptoms May Worsen Over Time

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessInjured Soldiers' Symptoms May Worsen Over TimeAaron LevinAaron LevinSearch for more papers by this authorPublished Online:6 Oct 2006https://doi.org/10.1176/pn.41.19.0022The psychological effects of combat trauma on U.S. soldiers seem to increase during the first year after they are wounded in Iraq or Afghanistan. Severely wounded soldiers had higher rates of posttraumatic stress disorder (PTSD) or depression seven months after their injuries than at one month, reported Army researchers in the October American Journal of Psychiatry.“A one-time evaluation doesn't give you the story of what's to come,” said co-author Capt. Thomas Grieger, M.C., an associate professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., in an interview. “Even among those who don't have PTSD at seven months, something may trigger symptoms in the next year or two.”About 79 percent of those who screened positive for PTSD or depression at seven months screened negative for both conditions at one month, wrote Grieger and six colleagues in their report. Greater severity of physical injury was the prime predictor of later PTSD or depression.“The course of illness in battle-injured soldiers is complex, and the initial assessments in this study were not predictive of the health or life impact of such injuries six months later,” they wrote.“Symptoms wax and wane over time,” Grieger told Psychiatric News. “Some individuals come close but don't meet the criteria at one point, but then cross over at another time.”The study included the first 613 U.S. soldiers hospitalized at Walter Reed Army Medical Center after being wounded in combat in Iraq or Afghanistan between March 2003 and September 2004. They all had multiple, serious injuries, including amputations and head trauma. In addition to their medical care, all were given psychiatric evaluations within 48 hours of arriving at Walter Reed and provided with psychiatric care while they were in the hospital.The soldiers were screened at one, four, and seven months; 243 soldiers underwent all three assessments (see chart for data on this group). Length of time in the war zones and information about specific traumatic events while deployed served to measure war exposure. The researchers used the National Center for PTSD Checklist and the Patient Health Questionnaire-9 depression scale to assess psychiatric symptoms.The Patient Health Questionnaire somatic symptoms severity scale measured severity of physical problems. This scale is based on subjective self-reports and was initially used to guide the patient's care. It was used in contrast to objective scales of injuries—those assessing loss of blood or missing limbs, for instance—that tend to be used more by trauma surgeons or emergency departments, Grieger said.The number of soldiers diagnosed varied with time. At the one-month assessment, 4.2 percent of the 613 soldiers met criteria for PTSD, 4.4 percent for depression, and 2 percent for both. Younger soldiers (under age 25) and those who were married were three times more likely to meet the standards for either disorder than older or unmarried soldiers.At four months, 12.2 percent of the 395 soldiers available for follow-up met the criteria for PTSD, 8.9 percent for depression, and 7.6 percent for both. At seven months, 12.0 percent of 301 soldiers met the criteria for PTSD, 9.3 percent for depression, and 6.3 percent for both.The researchers were able to assess the soldiers in the hospital, but lost track of about half after they returned home. However, the demographics and combat exposure in the one-month and seven-month cohorts were the same, said Grieger.If all soldiers who were diagnosed with PTSD at any time during the course of the study were combined, the rate would approach 17 percent, he said. That figure is close to the 18.9 percent reported in a recent reanalysis of the 1988 National Vietnam Veterans Readjustment Study.There were no demographic differences associated with PTSD or depression at the four- and seven-month evaluations. At one month, combat exposure was associated with PTSD but not depression, but at four or seven months, combat exposure was not associated with either PTSD or depression.Wounded soldiers have much going for them but also face obstacles in their return to life after combat, said Grieger. During their rehabilitation at Walter Reed, many display positive attitudes, close relations with their families, command support, and the camaraderie of fellow soldiers going through rehab. However, their ongoing physical problems may complicate their recovery once they leave the hospital.“We haven't studied it yet, but i'm especially concerned about reservists, who will go back to their hometowns where they may not have the same access to medical care or comrades to talk to,” he said.“Posttraumatic Stress Disorder and Depression in Battle-Injured Soldiers” is posted at<http://ajp.psychiatryonline.org> under the October issue. ▪ ISSUES NewArchived

Acute stress disorder and posttraumatic stress disorder symptoms among patients severely injured in motor vehicle accidents in Japan

Objective The prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in seriously injured survivors of motor vehicle accidents (MVAs) in Japan was investigated. Furthermore, predictive factors in the early stage for development of PTSD were evaluated. Method Subjects were consecutive samples ( N=100) of patients hospitalized with severe MVA injuries surveyed at two time points: within 1 month after the MVA and then 6 months later. In the first survey, we conducted the Acute Stress Disorder Interview and compiled results of a self-rating questionnaire; in the second survey, we conducted a structured clinical interview via telephone. Results The prevalence of ASD and PTSD were 9.0% and 8.5%, respectively. The shift from ASD to PTSD was more pronounced when we included partial diagnoses of ASD and PTSD. Three predictive factors for PTSD were identified through multiple logistic analysis: ASD-positive, presence of persistent physical disability and physical injury severity. Conclusions Even among severely injured MVA survivors, most acute stress symptoms subside over time. However, having ASD or partial ASD in the early stage, and the presence of physical disability as an aftereffect are strong predictive factors for PTSD. These findings validate the importance of evidence-based intervention for ASD to forestall PTSD.