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Meister RE, Weber T, Princip M, Schnyder U, Barth J, Znoj H, Schmid JP, von Känel R. Perception of a hectic hospital environment at admission relates to acute stress disorder symptoms in myocardial infarction patients. Gen Hosp Psychiatry 2016; 39:8-14. [PMID: 26725540 DOI: 10.1016/j.genhosppsych.2015.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/05/2015] [Accepted: 11/12/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Hospital crowding is a public health problem that may impact on the quality of medical treatment and increase the risk of developing traumatic stress, e.g., after myocardial infarction (MI). This study examines whether subjective appraisal of crowding at hospital admission due to MI is associated with acute stress disorder (ASD) symptoms. METHOD We investigated 102 consecutive patients with acute MI within 48h after having reached stable circulatory conditions. The appraisal of crowding was measured by the retrospective assessment of the perception of a hectic hospital environment at admission. Furthermore, patients completed the Acute Stress Disorder Scale to rate the psychological stress reaction. RESULTS The perception of a hectic hospital environment was associated with the development of ASD symptoms (r=0.254, P=.013) independently of demographic, peritraumatic and medical factors. Post hoc analysis revealed associations with dissociative (r=0.211, P=.041), reexperiencing (r=0.184, P=.074) and arousal (r=0.179, P=.083) symptoms. CONCLUSION The findings suggest that, besides objective circumstances, the way hospital admission due to MI is perceived by the patient may influence the development of MI-triggered ASD symptoms. The psychological and physiological long-term outcomes of the perception of a hectic hospital environment and the role of preventive interventions need further examination.
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Affiliation(s)
- Rebecca Elisabeth Meister
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Psychosomatic Research Group, Department of Clinical Research, University of Bern, Switzerland; Institute of Psychology, Division of Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
| | - Tania Weber
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Mary Princip
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Psychosomatic Research Group, Department of Clinical Research, University of Bern, Switzerland; Institute of Psychology, Division of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Switzerland
| | - Hansjörg Znoj
- Institute of Psychology, Division of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Jean-Paul Schmid
- Department of Cardiology, Bern University Hospital and Spital Netz Bern, Spital Tiefenau, Bern, Switzerland
| | - Roland von Känel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Psychosomatic Research Group, Department of Clinical Research, University of Bern, Switzerland; Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
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Pereira GF, McLean SA, Tkacik TJ, Swor RA, Jones JS, Lee DC, Peak DA, Domeier RM, Rathlev NK, Hendry PL, Platts-Mills TF. Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision. BMC Emerg Med 2014; 14:25. [PMID: 25547869 PMCID: PMC4307167 DOI: 10.1186/s12873-014-0025-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/09/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Motor vehicle collisions (MVCs) are the second most common injury mechanism resulting in emergency department (ED) visits by older adults. MVCs result in substantial pain and psychological distress among younger individuals, but little is known about the occurrence of these symptoms in older individuals. We describe the frequency of and characteristics associated with pain, distress, and anticipated time for physical and emotional recovery for older adults presenting to the ED after MVC in comparison to younger adults. METHODS In-person interviews were conducted for adults presenting to one of eight EDs after MVC without an obvious fracture or injury requiring admission as part of two prospective studies. Pain severity was assessed using a 0-10 verbal scale. Distress was assessed using the Peritraumatic Distress Inventory (range 0-52). Patients were asked to estimate their expected time for physical and emotional recovery; these responses were dichotomized to <30 or ≥30 days. ED pain and distress and associations between patient and collision characteristics and ED pain and distress were examined for patients age 65 years and older and patients age 18 to 64. RESULTS Older (n = 96) and younger (n = 943) adults had the same mean pain scores (5.5, SD 2.5 vs. 5.5, SD 2.4). Distress scores were lower in older than in younger adults (15.5, SD 9 vs. 19.2, SD 10). A higher percentage of older adults than younger adults had an anticipated time to physical recovery ≥30 days (41%, 95% confidence interval [CI] 28%-55% vs. 11%, 95% CI 9%-13%). Similarly, older adults were more likely to have an anticipated time for emotional recovery ≥30 days (45%, 95% CI 35%-55% vs. 17%, 95% CI 15%-20%). Older adults were less likely than younger adults to have moderate or severe neck pain (score ≥4) (25%, 95% CI 23% to 41% vs. 54%, 95% CI 48% to 60%) or back pain (31%, 95% CI 23% to 46% vs. 56%, 95% CI 51 to 62%) but more likely to have moderate or severe chest pain (42%, 95% CI 32% to 50% vs. 20%, 95% CI 16 to 23%). Pre-MVC depressive symptoms and pain catastrophizing were positively associated with pain and distress in both older and younger adults. CONCLUSIONS In our cohort, older adults who presented to the ED after MVC experienced similar pain severity as younger patients and less distress but were more likely to estimate their times for physical and emotional recovery to be 30 days or more. Increased emergency provider awareness of acute pain and distress symptoms among older patients experiencing MVC may improve outcomes for these patients.
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Affiliation(s)
- Gregory F Pereira
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
- Departments of Emergency Medicine and Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
| | - Thomas J Tkacik
- Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
| | - Robert A Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
| | - Jeffrey S Jones
- Department of Emergency Medicine, Spectrum Health - Butterworth Campus, Grand Rapids, MI, USA.
| | - David C Lee
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA.
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Robert M Domeier
- Department of Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI, USA.
| | - Niels K Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA.
| | - Phyllis L Hendry
- Department of Emergency Medicine and Pediatrics, University of Florida-Jacksonville, Jacksonville, FL, USA.
| | - Timothy F Platts-Mills
- Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
- Departments of Emergency Medicine and Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
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Weber U, Reitinger A, Erdeii T, Hellmich C, Steinlechner B, Hager H, Selzer M, Hiesmayr M, Rajek A, Kober A. Effects of high-urgency ambulance transportation on pro-B-type natriuretic peptide levels in patients with heart failure. Am J Emerg Med 2010; 28:568-76. [DOI: 10.1016/j.ajem.2008.12.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 12/17/2008] [Accepted: 12/19/2008] [Indexed: 11/26/2022] Open
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Dörges V, Wenzel V, Dix S, Kühl A, Schumann T, Hüppe M, Iven H, Gerlach K. The effect of midazolam on stress levels during simulated emergency medical service transport: a placebo-controlled, dose-response study. Anesth Analg 2002; 95:417-22, table of contents. [PMID: 12145064 DOI: 10.1097/00000539-200208000-00034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Patients in the emergency medical service (EMS) may have increased endogenous catecholamines because of pain or fear and may benefit from sedation similar to premedication in the hospital. During a simulated EMS scene call, 72 healthy male volunteers were either transported by paramedics from a third-floor apartment through a staircase with subsequent EMS transport with sirens (three stress groups of n = 12; total, n = 36) or asked to sit on a chair for 5 min and lie down on a stretcher for 15 min (three control groups of n = 12; total, n = 36). Catecholamine plasma samples were measured in the respective stress and control groups at baseline and after placebo IV (n = 12) or 25 (n = 12) or 50 (n = 12) microg/kg of midazolam IV throughout the experiment, respectively. Statistical analysis was performed with analysis of variance; P < 0.05 was considered significant. The Placebo Stress versus Control group, but not the 50 microg/kg Stress Midazolam group, had both significantly increased epinephrine (73 +/- 5 pg/mL versus 45 +/- 5 pg/mL; P < 0.001) and norepinephrine (398 +/- 34 pg/mL versus 278 +/- 23 pg/mL; P < 0.01) plasma levels after staircase transport. After EMS transport, the Placebo Stress versus Control group had significantly increased epinephrine (51 +/- 4 pg/mL versus 37 +/- 4 pg/mL; P < 0.05) but not norepinephrine (216 +/- 24 pg/mL versus 237 +/- 18 pg/mL) plasma levels, whereas no significant differences in catecholamine plasma levels occurred between groups after either 25 or 50 microg/kg of midazolam. In conclusion, simulated EMS patients may be subject to more stress during staircase transport than during transport in an EMS vehicle. Titrating sedation with 25 microg/kg of midazolam significantly reduced endogenous catecholamines but not heart rate. IMPLICATIONS Simulated emergency medical service patients were more likely to be stressed when being transported by paramedics through a staircase than in an ambulance. Accordingly, it may be beneficial to inject sedative drugs before initiating transport to ensure patient comfort and safety.
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Affiliation(s)
- Volker Dörges
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Kiel, Germany.
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Dörges V, Wenzel V, Dix S, Kühl A, Schumann T, Hüppe M, Iven H, Gerlach K. The Effect of Midazolam on Stress Levels During Simulated Emergency Medical Service Transport: A Placebo-Controlled, Dose-Response Study. Anesth Analg 2002. [DOI: 10.1213/00000539-200208000-00034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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