2 results
A nationwide US study of post-traumatic stress after hospitalization for physical injury
- DOUGLAS F. ZATZICK, FREDERICK P. RIVARA, AVERY B. NATHENS, GREGORY J. JURKOVICH, JIN WANG, MING-YU FAN, JOAN RUSSO, DAVID S. SALKEVER, ELLEN J. MACKENZIE
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- Journal:
- Psychological Medicine / Volume 37 / Issue 10 / October 2007
- Published online by Cambridge University Press:
- 11 June 2007, pp. 1469-1480
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- Article
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Background
Injured survivors of individual and mass trauma are at risk for developing post-traumatic stress disorder (PTSD). Few investigations have assessed PTSD after injury in large samples across diverse acute care hospital settings.
MethodA total of 2931 injured trauma survivors aged 18–84 who were representative of 9983 in-patients were recruited from 69 hospitals across the USA. In-patient medical records were abstracted, and hospitalized patients were interviewed at 3 and 12 months after injury. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist (PCL) 12 months after injury.
ResultsApproximately 23% of injury survivors had symptoms consistent with a diagnosis of PTSD 12 months after their hospitalization. Greater levels of early post-injury emotional distress and physical pain were associated with an increased risk of symptoms consistent with a PTSD diagnosis. Pre-injury, intensive care unit (ICU) admission [relative risk (RR) 1·17, 95% confidence interval (CI) 1·02–1·34], pre-injury depression (RR 1·33, 95% CI 1·15–1·54), benzodiazepine prescription (RR 1·46, 95% CI 1·17–1·84) and intentional injury (RR 1·32, 95% CI 1·04–1·67) were independently associated with an increased risk of symptoms consistent with a PTSD diagnosis. White injury survivors without insurance demonstrated approximately twice the rate of symptoms consistent with a diagnosis of PTSD when compared to white individuals with private insurance. By contrast, for Hispanic injury survivors PTSD rates were approximately equal between uninsured and privately insured individuals.
ConclusionsNationwide in the USA, more than 20% of injured trauma survivors have symptoms consistent with a diagnosis of PTSD 12 months after acute care in-patient hospitalization. Coordinated investigative and policy efforts could target mandates for high-quality PTSD screening and intervention in acute care medical settings.
3 - Measurement of Injury Severity and Co-morbidity
- Edited by Frederick P. Rivara, Harborview Injury Prevention and Research Center, Seattle, Peter Cummings, Harborview Injury Prevention and Research Center, Seattle, Thomas D. Koepsell, Harborview Injury Prevention and Research Center, Seattle, David C. Grossman, Harborview Injury Prevention and Research Center, Seattle, Ronald V. Maier, Harborview Injury Prevention and Research Center, Seattle
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- Book:
- Injury Control
- Published online:
- 16 October 2009
- Print publication:
- 27 November 2000, pp 32-46
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- Chapter
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Summary
This chapter describes existing measures of injury severity, reviews the rationale for their development, and discusses their use and important limitations. Scoring systems based upon the anatomic injury are an important method of measuring injury severity and are critical to injury epidemiology, injury prevention, trauma system development and outcome analysis. In addition to the information captured by scales of anatomic injury severity, measures of the physiologic response to injury such as heart rate (HR), systolic blood pressure (SBP), respiratory rate (RR), and level of consciousness are also important indicators of the severity of an injury. By combining measures of the severity of anatomic injury with those of acute physiologic derangement and age, it has been possible to provide statistically strong estimates of survival probability following trauma. Finally, the chapter also reviews the measures of co-morbidity, the term used to describe health status factors likely to influence the outcome after injury.