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Bérubé M, Bradley N, O'Donnell M, Stelfox HT, Garraway N, Vasiliadis HM, Turcotte V, Perreault M, Menear M, Archambault L, Haagsma J, Provencher H, Genest C, Gagnon MA, Bourque L, Lapierre A, Khalfi A, Panenka W. Clinical practice guideline recommendations to improve the mental health of adult trauma patients: protocol for a systematic review. BMJ Open 2024; 14:e079205. [PMID: 38531562 DOI: 10.1136/bmjopen-2023-079205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Mental disorders are common in adult patients with traumatic injuries. To limit the burden of poor psychological well-being in this population, recognised authorities have issued recommendations through clinical practice guidelines (CPGs). However, the uptake of evidence-based recommendations to improve the mental health of trauma patients has been low until recently. This may be explained by the complexity of optimising mental health practices and interpretating CGPs scope and quality. Our aim is to systematically review CPG mental health recommendations in the context of trauma care and appraise their quality. METHODS AND ANALYSIS We will identify CPG through a search strategy applied to Medline, Embase, CINAHL, PsycINFO and Web of Science databases, as well as guidelines repositories and websites of trauma associations. We will target CPGs on adult and acute trauma populations including at least one recommendation on any prevention, screening, assessment, intervention, patient and family engagement, referral or follow-up procedure related to mental health endorsed by recognised organisations in high-income countries. No language limitations will be applied, and we will limit the search to the last 15 years. Pairs of reviewers will independently screen titles, abstracts, full texts, and carry out data extraction and quality assessment of CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) II. We will synthesise the evidence on recommendations for CPGs rated as moderate or high quality using a matrix based on the Grading of Recommendations Assessment, Development and Evaluation quality of evidence, strength of recommendation, health and social determinants and whether recommendations were made using a population-based approach. ETHICS AND DISSEMINATION Ethics approval is not required, as we will conduct secondary analysis of published data. The results will be disseminated in a peer-reviewed journal, at international and national scientific meetings. Accessible summary will be distributed to interested parties through professional, healthcare quality and persons with lived experience associations. PROSPERO REGISTRATION NUMBER: (ID454728).
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Affiliation(s)
- Mélanie Bérubé
- Population Health and Optimal Practices Research Unit Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, Québec, Quebec, Canada
- Faculty of Nursing, Université Laval, Québec City, Quebec, Canada
| | - Nori Bradley
- University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Meaghan O'Donnell
- Department of Psychiatry, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Henry Thomas Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naisan Garraway
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Valerie Turcotte
- Department of Social and Preventive Medicine, Université Laval, Québec City, Quebec, Canada
| | - Michel Perreault
- Institut universitaire en santé mentale Douglas, Montréal, Quebec, Canada
| | - Matthew Menear
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Quebec, Canada
| | - Léonie Archambault
- Institut universitaire en santé mentale Douglas, Montréal, Quebec, Canada
| | - Juanita Haagsma
- Faculty of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Christine Genest
- Faculté des sciences infirmières, Université de Montréal, Montréal, Quebec, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Quebec, Canada
| | - Marc-Aurèle Gagnon
- Population Health and Optimal Practices Research Unit Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, Québec, Quebec, Canada
| | - Laurence Bourque
- Population Health and Optimal Practices Research Unit Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, Québec, Quebec, Canada
| | - Alexandra Lapierre
- Population Health and Optimal Practices Research Unit Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, Québec, Quebec, Canada
| | - Amal Khalfi
- Faculty of Nursing, Université Laval, Québec City, Quebec, Canada
| | - William Panenka
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
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Boyapati RM, Nehrbas J, Yarboro SR, Hadeed MM. Traumatic brain injury is common and undertreated in the orthopaedic trauma population. Injury 2024; 55:111325. [PMID: 38241955 DOI: 10.1016/j.injury.2024.111325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Traumatic brain injuries (TBIs) can be difficult to diagnose and are often marginalized when compared to more obvious physical injuries. Despite this, recognition and early treatment can lead to improved outcomes. Even mild TBIs have the potential to cause significant long-term consequences for patients, which may affect their physical recovery from orthopaedic injuries. The objective of this study was to examine the incidence and treatment of TBI within the orthopaedic trauma population. METHODS Inclusion criteria were all patients presenting after an acute trauma with an orthopaedic surgery consult over a continuous 3 month timeframe (n = 187). A retrospective review was completed at an academic tertiary referral trauma center. The primary outcome was the rate of TBI. Secondary outcomes included rate of TBI listed as a discharge diagnosis and rate of follow up plan. Several secondary variables were noted and their associations with TBI evaluated. RESULTS 27 % of the 187 patients had an acute TBI. 61 % of TBI patients had the diagnosis listed in their discharge summary. 6 % had a follow up plan. The positive TBI group was associated with more high energy injuries (p = 0.032), average limbs involved (p = 0.007), upper extremity injury (p < 0.001), bilateral lower extremity injury (p = 0.004), and Injury Severity Score (p < 0.001). 82 % of patients with an acute TBI had an occupational therapy consult and 39 % had a neurosurgery consult. 24 % of patients with a TBI were admitted to the orthopaedic primary service. CONCLUSIONS Patients presenting after an acute trauma with orthopaedic injuries have high rates of TBI, but low rates of diagnosis and treatment. This lack of diagnosis and treatment can negatively impact recovery from orthopaedic injuries. Orthopaedic providers should be aware of the diagnostic criteria and initial treatment steps for TBI to ensure prompt and effective treatment, which has been shown to improve outcomes.
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Affiliation(s)
- Rohan M Boyapati
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States
| | - Jill Nehrbas
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States
| | - Seth R Yarboro
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States
| | - Michael M Hadeed
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States.
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Traumatic brain injuries are ignored or discriminated in prospective clinical trials on shoulder fractures: a systematic review. INTERNATIONAL ORTHOPAEDICS 2023; 47:17-50. [PMID: 36435944 DOI: 10.1007/s00264-022-05642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Current literature suggests a significant epidemiological association between traumatic brain injury (TBI) and proximal upper limb fractures in addition to major clinical consequences. A systematic review was conducted to assess how TBI is taken into consideration in interventional studies on shoulder fractures. METHODS The following data sources were used: MEDLINE, EMBASE, EBM Reviews, CINAHL, and OpenGrey databases. Study selection included interventional randomized clinical trials and prospective cohort studies on shoulder fractures published in English or French between 2008 and 2020. Studies on pathologic fractures, chronic fracture complications, nonhuman subjects, and biomechanics were excluded. Articles were reviewed by two independent authors according to the PRISMA guidelines. Baseline characteristics, exclusion criteria, and input relevant to TBI were recorded. Methodological quality was assessed with the Cochrane risk of bias tool for randomized clinical trials and the Newcastle-Ottawa Scale for cohort studies. RESULTS One-hundred-thirteen studies met the inclusion criteria. None discussed the possible impact of TBI on their results. Only three (2.7%) studies considered TBI relevant and included these patients in their cohort. Furthermore, 43/113 (38.1%) excluded patients with injuries or mechanisms strongly related to traumatic brain injuries: head injuries (4); moderate and/or severe TBI (7); high energy traumas (3); Polytrauma subjects (33). CONCLUSION TBI are ignored or discriminated in prospective clinical trials on shoulder fractures. The exclusion of these cases impacts generalizability as their prevalence is significant. Considering the major impact of TBI on important outcomes, its presence should always be assessed to ensure high quality evidence. LEVEL OF EVIDENCE Systematic Review, Therapeutic Level II.
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Al Hariri M, Zgheib H, Abi Chebl K, Azar M, Hitti E, Bizri M, Rizk J, Kobeissy F, Mufarrij A. Assessing the psychological impact of Beirut Port blast: A cross-sectional study. Medicine (Baltimore) 2022; 101:e31117. [PMID: 36253992 PMCID: PMC9575829 DOI: 10.1097/md.0000000000031117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Beirut Port blast's magnitude is considered the third after Hiroshima and Nagasaki atomic bombings. This blast occurred in the densely populated section of Beirut, leaving more than six thousand injured patients. The psychological disturbances were assessed in the blast survivors who presented to the Emergency Department (ED) at the American University of Beirut Medical Center (AUBMC). This was a cross-sectional study at the ED of AUBMC. Identified patients were contacted and consented to participate in the study. Post-Traumatic Stress Disorder (PTSD) was selected as an outcome. Depression, PTSD, and concussion were assessed using patient health questionnaire (PHQ)-9, PTSD checklist for DSM-5 (PCL5), and brain injury symptoms (BISx) tools, respectively. The association of patients and injury characteristics with the study outcome was assessed using logistic regression. 145 participants completed the study procedures. The participants' average age was 39.8 ± 15.4 years, and 60% were males. Almost half of the participants showed depression on PHQ, and 2-thirds had PTSD. The participant's age was negatively associated with PTSD, whereas being a female, having depression, and having a concussion were positively associated with PTSD. The results of this study were in line with the previous literature report except for the association between younger age and PTSD, which warrants further investigations to delineate the reasons.
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Affiliation(s)
- Moustafa Al Hariri
- Vice President for Medical and Health Science Office, QU Health, Qatar University, Doha, Qatar
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hady Zgheib
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karen Abi Chebl
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maria Azar
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Bizri
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jennifer Rizk
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Afif Mufarrij
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- *Correspondence: Afif Mufarrij, Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236/ Riad El-Solh/ Beirut 1107 2020, Lebanon (e-mail: )
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Sinkler MA, Furdock RJ, Vallier HA. Treating trauma more effectively: A review of psychosocial programming. Injury 2022; 53:1756-1764. [PMID: 35491278 DOI: 10.1016/j.injury.2022.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Traumatic events are the leading cause of life-altering disability in adults of working age. The management of patients with traumatic injury has substantially improved due to development of sophisticated trauma centers increasing survival after injury. Unlike the adoption of the trauma system framework, the same has not occurred with specialized trauma recovery services to include mental and social health needs. This literature review will discuss unique issues facing trauma survivors, some current recovery programs available, outcomes and benefits of these programs, and barriers that impair widespread incorporation. OBSERVATIONS Studies have shown that patients with traumatic injury experience reduction in quality of life and concurrent threats to mental health, including post-traumatic stress disorder (PTSD), alcohol use disorder, and recreational substance abuse. Patients with traumatic injury also have high recidivism rates, low pain management satisfaction, and poor engagement in care following injury. Screening efforts for PTSD, mental illness, and alcohol and substance abuse are more widely available interventions. Early coordinated efforts included dedicated multidisciplinary recovery teams. Recently, more methodical and organized programs, such as the Trauma Survivors Network, trauma collaborative care, Trauma Recovery Services, and Center of Trauma Survivorship, have been implemented. CONCLUSIONS AND RELEVANCE The enrollment of patients with traumatic injury in novel programs to enhance recovery has led to heightened self-efficacy, better coping mechanisms, and increased use of mental health services. Additionally, trauma recovery services have been shown to reduce recidivism and have generated cost savings for hospital systems. While positive outcomes have been demonstrated, they are not consistently predictable. Barriers for widespread implementation include limitations of time, funding, and institutional support. This article describes models of successful programs initiated within some trauma centers, which may be duplicated to serve future trauma survivors.
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Affiliation(s)
- Margaret A Sinkler
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ryan J Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH.
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Shahim P, Zetterberg H. Neurochemical Markers of Traumatic Brain Injury: Relevance to Acute Diagnostics, Disease Monitoring, and Neuropsychiatric Outcome Prediction. Biol Psychiatry 2022; 91:405-412. [PMID: 34857362 DOI: 10.1016/j.biopsych.2021.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/13/2022]
Abstract
Considerable advancements have been made in the quantification of biofluid-based biomarkers for traumatic brain injury (TBI), which provide a clinically accessible window to investigate disease mechanisms and progression. Methods with improved analytical sensitivity compared with standard immunoassays are increasingly used, and blood tests are being used in the diagnosis, monitoring, and outcome prediction of TBI. Most work to date has focused on acute TBI diagnostics, while the literature on biomarkers for long-term sequelae is relatively scarce. In this review, we give an update on the latest developments in biofluid-based biomarker research in TBI and discuss how acute and prolonged biomarker changes can be used to detect and quantify brain injury and predict clinical outcome and neuropsychiatric sequelae.
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Affiliation(s)
- Pashtun Shahim
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at University College London, London, United Kingdom; Department of Neurodegenerative Disease, University College London Institute of Neurology, London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China.
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Wang X, Li X, Qi M, Hu X, Zhu H, Shi X. Incidence of post-traumatic stress disorder in survivors of traumatic fracture: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2021; 27:902-916. [PMID: 34313497 DOI: 10.1080/13548506.2021.1957953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Post-traumatic stress disorder (PTSD) is prevalent in traumatic events. It is a great hazard of physical and mental health due to their severity and frequency. Traumatic fractures are one of the major causes of PTSD. The incidence of traumatic fractures has been high in recent years, which will directly or indirectly result in PTSD. Our target is to estimate the pooled incidence of PTSD in fracture patients after traumatic events and to explore possible influencing factors by a meta-analysis.The systematic searches in the electronic bibliographic databases of Web of Science, ScienceDirect, Ovid MEDLINE, PubMed, CNKI (China National Knowledge Infrastructure), Wangfang , and Veipu Databases. Not only were heterogeneity and 95% confidence interval (CI) used for comprehensive assessing each pooled, but also was the P value. Subgroup analyses for some sample characteristics were calculated the pooled incidence of PTSD among patients suffered from fractures.In total, 2619 patients suffered from fracture, and were assessed PTSD in the 12 eligible studies. The heterogeneity was not low (I2 = 97.6%, P < 0.001) in the 12 eligible studies. The pooled incidence of PTSD in fracture patients was 29% (95% CI, 20% to 39%) using random-effects model. Subgroup analyses revealed that the pooled incidence of PTSD among patients after traumatic fracture was statistically significant differences according to the study design, the study location, tools to assess the symptoms of PTSD, the mean age and injury mechanism (all P < 0.001). Fracture sites, injury mechanism and pain were the main influencing factors of PTSD in fracture patients.Our results highlight the phenomenon that high incidence of PTSD in patients after fracture and they should be followed up regularly and be provided effective interventions. Future efforts to improve and control the main influencing factors of PTSD for this population still needed.
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Affiliation(s)
- Xue Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, China
| | - Xiahong Li
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, China
| | - Miao Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, China
| | - Xiuli Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, China
| | - Huiping Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Center for Injury Research and Policy & Center for Pediatric Trauma Research, the Research Institute at Nationwide Children's Hospital, the Ohio State University College of Medicine, Columbus, USA
| | - Xiuquan Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, China.,Center for Injury Research and Policy & Center for Pediatric Trauma Research, the Research Institute at Nationwide Children's Hospital, the Ohio State University College of Medicine, Columbus, USA
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Joseph NM, Benedick A, Flanagan CD, Breslin MA, Vallier HA. Risk Factors for Posttraumatic Stress Disorder in Acute Trauma Patients. J Orthop Trauma 2021; 35:e209-e215. [PMID: 33724967 DOI: 10.1097/bot.0000000000001990] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify risk factors for posttraumatic stress disorder (PTSD) after traumatic injury. SETTING Single urban Level I trauma center. DESIGN Prospective. PATIENTS/PARTICIPANTS Three hundred men (66%) and 152 women treated for traumatic injuries were administered the PTSD checklist for a Diagnostic and Statistical Manual of Mental Disorders fifth edition (PCL-5) survey during their first post-hospital visit over a 15-month period. INTERVENTION Screening for PTSD in trauma patients. MAIN OUTCOME MEASUREMENT The prevalence of disease and risk factors for the development of PTSD based on demographic, medical, injury, and treatment variables. RESULTS One hundred three patients screened positive for PTSD (26%) after a mean of 86 days after injury. Age less than 45 years was an independent risk factor for the development of PTSD [odds ratio (OR) 2.64, 95% confidence interval (CI) (1.40-4.99)]. Mechanisms of injury associated with the development of PTSD included pedestrians struck by motor vehicles [OR 7.35, 95% CI (1.58-34.19)], motorcycle/all terrain vehicle crash [OR 3.17, 95% CI (1.04-9.65)], and victims of crime [OR 3.49, 95% CI (0.99-9.20)]. Patients sustaining high-energy mechanism injuries and those who were victims of crime scored higher on the PCL-5 [OR 2.39, 95% CI (1.35-4.22); OR 4.50, 95% CI (2.52-8.05), respectively]. CONCLUSIONS One quarter of trauma patients screened positive for PTSD at 3 months after their injury. A mechanism of injury is a risk factor for PTSD, and younger adults, victims of crime, and pedestrians struck by motor vehicles are at higher risk. These findings offer the potential to more effectively target and refer vulnerable patient populations to appropriate treatment. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a compete description of levels of evidence.
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Affiliation(s)
- Noah M Joseph
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, affiliated with the Case Western Reserve University
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The Psychological Effects of Musculoskeletal Trauma. J Am Acad Orthop Surg 2021; 29:e322-e329. [PMID: 33475305 DOI: 10.5435/jaaos-d-20-00637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/22/2020] [Indexed: 02/01/2023] Open
Abstract
Musculoskeletal injuries comprise a large percentage of hospital admissions for adults and often contribute to persistent daily pain as an illness; opioid dependence; disability; and complaints of increased depression, anxiety, and symptoms of post-traumatic stress disorder. The prevalence of depression and post-traumatic stress disorder after orthopaedic trauma has been found to be considerably greater than the general adult cohort. Soon after sustaining a fracture, psychological factors can predict pain and disability many months after injury, even after controlling for injury severity. Thus, early in the care of orthopaedic trauma, there exists an opportunity to improve overall health by attending to psychological and social concerns, along with physical health. Recent literature has identified clinically actionable subgroups within the orthopaedic trauma cohort that are at psychological risk after an injury. Improving positive factors such as resilience, social support, and self-efficacy via validated interventions such as Cognitive-Behavioral Therapy, mindfulness training, and other types of mindset training has helped people return to their daily routine. Raising awareness of the psychological effects of trauma among the orthopaedic community could improve post-treatment planning, increase referrals to appropriate nonmedical professionals, and implement earlier effective interventions.
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Saladino V, Algeri D, Auriemma V. The Psychological and Social Impact of Covid-19: New Perspectives of Well-Being. Front Psychol 2020; 11:577684. [PMID: 33132986 PMCID: PMC7561673 DOI: 10.3389/fpsyg.2020.577684] [Citation(s) in RCA: 214] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022] Open
Abstract
The recent Covid-19 pandemic has had significant psychological and social effects on the population. Research has highlighted the impact on psychological well-being of the most exposed groups, including children, college students, and health workers, who are more likely to develop post-traumatic stress disorder, anxiety, depression, and other symptoms of distress. The social distance and the security measures have affected the relationship among people and their perception of empathy toward others. From this perspective, telepsychology and technological devices assume important roles to decrease the negative effects of the pandemic. These tools present benefits that could improve psychological treatment of patients online, such as the possibility to meet from home or from the workplace, saving money and time and maintaining the relationship between therapists and patients. The aim of this paper is to show empirical data from recent studies on the effect of the pandemic and reflect on possible interventions based on technological tools.
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Affiliation(s)
- Valeria Saladino
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio of Cassino, Cassino, Italy
| | | | - Vincenzo Auriemma
- Department of Political and Social Studies, Sociology, University of Salerno, Fisciano, Italy
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Kirven JC, Everhart JS, DiBartola AC, Jones J, Flanigan DC, Harrison R. Interventional Efforts to Reduce Psychological Distress After Orthopedic Trauma: A Systematic Review. HSS J 2020; 16:250-260. [PMID: 33088239 PMCID: PMC7534886 DOI: 10.1007/s11420-019-09731-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unanticipated severe injury to part of the musculoskeletal system, referred to as orthopedic trauma, can be debilitating. It can also be accompanied by equally debilitating psychological distress, but little is known about the effective interventions for psychological sequelae of orthopedic trauma. QUESTIONS/PURPOSES We sought to determine the effectiveness of interventions on psychological outcomes, such as post-traumatic stress disorder (PTSD), depression, and pain catastrophizing (feelings of helplessness, excessive rumination, and exaggerated description of pain), after major orthopedic trauma. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement as guidelines, we systematically searched Scopus, PubMed, and Google Scholar. Studies included for review were English-language interventional studies in an orthopedic trauma population that included assessment of post-injury psychological distress or disability as either a primary or secondary aim. RESULTS Twelve studies were identified, including six randomized trials, three prospective cohort studies, and three retrospective cohort studies. Study sample sizes ranged from 48 to 569 patients, the mean age ranged from 29 to 52.8 years, and the percentage of male patients ranged from 38 to 90%. We examined four categories of interventions. Peer group treatment (one study) significantly reduced rates of depression but had low participation rates. Brief interventions to teach coping and self-efficacy skills (two studies) decreased depression, pain catastrophizing, and anxiety scores while increasing self-efficacy on short-term follow-up. Individualized counseling and rehabilitation (four studies) resulted in a consistent reduction in the risk of PTSD. Early amputation was found to result in lower rates of PSTD than limb salvage in US military personnel (four studies). One study examined surgeons' confidence in dealing with possible psychological distress; surgeons who participated in a program on collaborative care were significantly more confident that they could help their patients with such issues. CONCLUSION Interventional strategies, including group interventions, brief individual interventions, longitudinal counseling, and consideration of early amputation in selected populations have proved effective in reducing negative psychological sequelae of major orthopedic trauma. Further research that determines the effects of interventions in this population is needed.
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Affiliation(s)
- James C. Kirven
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811Sports Medicine, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Joshua S. Everhart
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - Alex C. DiBartola
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - Jeremy Jones
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - David C. Flanigan
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811Sports Medicine, Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Cartilage Restoration Program, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Ryan Harrison
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
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Shelley JK, Roden-Foreman JW, Vier D, McShan EE, Bennett MM, Jones AL, Warren AM. Relation of length of stay and other hospital variables to posttraumatic stress disorder and depression after orthopedic trauma. Proc AMIA Symp 2020; 34:28-33. [PMID: 33456140 PMCID: PMC7785185 DOI: 10.1080/08998280.2020.1801113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) and depression are common following orthopedic trauma. This study examined the relationship between injury- and hospital-related variables and PTSD and depression at baseline and 12 months after orthopedic trauma. This longitudinal, prospective cohort study examined adult orthopedic trauma patients admitted ≥24 hours to a level I trauma center. Non-English/Spanish-speaking and cognitively impaired patients were excluded. The Primary Care PTSD screen and PTSD Checklist-Civilian version assessed PTSD, and the Patient Health Questionnaire 8-Item assessed depression. Demographic and hospital-related variables were examined (e.g., hospital length of stay, Injury Severity Score, Glasgow Coma Scale). For 160 participants, PTSD prevalence was 23% at baseline and 21% at 12 months. Depression prevalence was 28% at baseline and 29% at 12 months. Ventilation (P = 0.023, P = 0.006) and prolonged length of stay (P = 0.008, P = 0.003) were correlated with baseline PTSD and depression. Injury etiology (P = 0.008) and Injury Severity Score (P = 0.013) were associated with baseline PTSD. Intensive care unit admission (P = 0.016, P = 0.043) was also correlated with PTSD at baseline and 12 months. Ventilation (P = 0.002, P = 0.040) and prolonged length of stay (P < 0.001, P = 0.001) were correlated with 12-month PTSD and depression. Early and continued screenings with potential interventions could benefit patients' physical and mental rehabilitation after orthopedic injury.
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Affiliation(s)
- Jordin K. Shelley
- Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Jacob W. Roden-Foreman
- Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - David Vier
- Department of Orthopaedic Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Evan Elizabeth McShan
- Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Monica M. Bennett
- Office of the Chief Medical Officer, Baylor Scott & White Health, Dallas, Texas
| | - Alan L. Jones
- Department of Orthopaedic Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Ann Marie Warren
- Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
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13
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Psychological factors and recovery from trauma. Injury 2020; 51 Suppl 2:S64-S66. [PMID: 31676072 DOI: 10.1016/j.injury.2019.10.081] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
Recent research has identified a high prevalence of psychological illnesses in patients who have sustained orthopaedic trauma. Depressive symptoms in this patient population have been reported to range from 13% to as high as 56%. Moreover, symptoms of depression, catastrophic thinking, and post-traumatic stress disorder (PTSD), have been consistently shown to negatively impact patient outcomes following treatment for their traumatic injuries. Specifically, patients with higher levels of psychosocial dysfunction have shown increased levels of pain, disability, and complications throughout their recovery. However, current research in orthopaedic trauma continues to be substantially focused on the physical and technical factors involved in the treatment of orthopaedic injuries. More research which applies the "biopsychosocial model" of health and evaluates the significant impact of psychological and social factors on recovery from trauma is needed. In particular, investigation which evaluates effective screening strategies and interventions to treat psychosocial dysfunction during recovery from trauma is highly desirable. This article reviews the current state of knowledge in this area and suggests future directions for research.
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14
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Psychological morbidity and functional impairment following traumatic pelvic injury. Injury 2020; 51:978-983. [PMID: 32081393 DOI: 10.1016/j.injury.2020.02.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
Pelvic injuries often result from high-energy trauma and lead to significant functional impairment. While the physical outcomes of these injuries have been widely studied, the psychological consequences remain largely unexplored. The purpose of this study was to examine psychosocial and functional outcomes of patients with pelvic trauma in the year after injury. The sample (N = 32) consisted of adult patients with traumatic pelvic injures, as defined by ICD-9 codes, who were admitted to a Level I Trauma Center for at least 24 h. Participants were primarily female (53%) with a mean age of 48.7 years (SD = 17.9). Demographic, injury-related, and psychosocial data (e.g., posttraumatic stress disorder (PTSD), depression, alcohol use, quality of life, pain, return to work) were gathered at the time of hospitalization as well as at 3-, 6-, and 12 month follow-ups. Mixed regression models were used to examine the outcome variables over time. There were significant decreases in pain and alcohol use at each follow-up compared to baseline. However, despite the decrease, the levels of pain and alcohol use remained high. Physical and mental health also decreased significantly, indicating worsened functioning and lowered quality of life. Neither PTSD nor depression changed significantly over time, indicating that participants' symptoms were not likely to improve. These data suggest that sustaining a traumatic pelvic injury increases the risk of diminished quality of life, both mentally and physically. Even one-year post-injury, participants experienced moderate physical pain and higher levels of PTSD, depression, and problematic alcohol use than would be expected in the general population. These findings highlight the need for an interdisciplinary approach to treating patients with pelvic injuries, including psychological screening and intervention in acute care and throughout recovery.
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Abstract
Objective To determine the prevalence of positive screening for posttraumatic stress disorder (PTSD) amongst trauma patients. Design Prospective, longitudinal study. Setting Single urban US level 1 trauma center. Patients and methods Four hundred fifty-two adult trauma patients were administered the PTSD checklist for DSM-V (PCL-5) survey upon posthospital outpatient clinic visit. This included 300 men (66%) and 152 women with mean age 43.8 years and mean Injury Severity Score (ISS) 11.3, with 83% having fractures of the pelvis and/or extremities. Medical and injury related variables were recorded. Multivariate logistic regression analysis was performed to identify factors predictive of screening positive for PTSD. Main outcome measurement Prevalence and risk factors for screening positive for PTSD amongst the trauma patient population. Results Twenty-six percent of trauma patients screened positive for PTSD after mean 86 days following injury. These patients were younger (35 vs 46 years old, P < 0.001) and more commonly African American (56% vs 43% Caucasian, P < 0.001). Pedestrians struck by motor vehicles (OR 4.70, P = 0.040) and victims of crime (OR 4.12, P = 0.013) were more likely to screen positive. Psychiatric history, injury severity (ISS), and injury type did not predict positive screening. Conclusion One-in-four patients suffering traumatic injuries screened positive for PTSD suggesting the prevalence of PTSD among trauma patients far exceeds that of the general population. Predictive factors included victims of crime and pedestrians struck by motor vehicles. Screening measures are needed in orthopaedic trauma surgery clinics to refer these at-risk patients for proper evaluation and treatment. Level of evidence Prognostic; Level II.
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16
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Nelson LD, Temkin NR, Dikmen S, Barber J, Giacino JT, Yuh E, Levin HS, McCrea MA, Stein MB, Mukherjee P, Okonkwo DO, Robertson CS, Diaz-Arrastia R, Manley GT, Adeoye O, Badjatia N, Boase K, Bodien Y, Bullock MR, Chesnut R, Corrigan JD, Crawford K, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson A, Foreman B, Gardner R, Gaudette E, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Jain S, Korley F, Kramer J, Kreitzer N, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, Merchant R, Noel F, Palacios E, Perl D, Puccio A, Rabinowitz M, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Sherer M, Taylor S, Toga A, Valadka A, Vassar MJ, Vespa P, Wang K, Yue JK, Zafonte R. Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study. JAMA Neurol 2019; 76:1049-1059. [PMID: 31157856 DOI: 10.1001/jamaneurol.2019.1313] [Citation(s) in RCA: 234] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Most traumatic brain injuries (TBIs) are classified as mild (mTBI) based on admission Glasgow Coma Scale (GCS) scores of 13 to 15. The prevalence of persistent functional limitations for these patients is unclear. Objectives To characterize the natural history of recovery of daily function following mTBI vs peripheral orthopedic traumatic injury in the first 12 months postinjury using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, and, using clinical computed tomographic (CT) scans, examine whether the presence (CT+) or absence (CT-) of acute intracranial findings in the mTBI group was associated with outcomes. Design, Setting, and Participants TRACK-TBI, a cohort study of patients with mTBI presenting to US level I trauma centers, enrolled patients from February 26, 2014, to August 8, 2018, and followed up for 12 months. A total of 1453 patients at 11 level I trauma center emergency departments or inpatient units met inclusion criteria (ie, mTBI [n = 1154] or peripheral orthopedic traumatic injury [n = 299]) and were enrolled within 24 hours of injury; mTBI participants had admission GCS scores of 13 to 15 and clinical head CT scans. Patients with peripheral orthopedic trauma injury served as the control (OTC) group. Exposures Participants with mTBI or OTC. Main Outcomes and Measures The Glasgow Outcome Scale Extended (GOSE) scale score, reflecting injury-related functional limitations across broad life domains at 2 weeks and 3, 6, and 12 months postinjury was the primary outcome. The possible score range of the GOSE score is 1 (dead) to 8 (upper good recovery), with a score less than 8 indicating some degree of functional impairment. Results Of the 1453 participants, 953 (65.6%) were men; mean (SD) age was 40.9 (17.1) years in the mTBI group and 40.9 (15.4) years in the OTC group. Most participants (mTBI, 87%; OTC, 93%) reported functional limitations (GOSE <8) at 2 weeks postinjury. At 12 months, the percentage of mTBI participants reporting functional limitations was 53% (95% CI, 49%-56%) vs 38% (95% CI, 30%-45%) for OTCs. A higher percentage of CT+ patients reported impairment (61%) compared with the mTBI CT- group (49%; relative risk [RR], 1.24; 95% CI, 1.08-1.43) and a higher percentage in the mTBI CT-group compared with the OTC group (RR, 1.28; 95% CI, 1.02-1.60). Conclusions and Relevance Most patients with mTBI presenting to US level I trauma centers report persistent, injury-related life difficulties at 1 year postinjury, suggesting the need for more systematic follow-up of patients with mTBI to provide treatments and reduce the risk of chronic problems after mTBI.
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Affiliation(s)
| | | | | | | | - Joseph T Giacino
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston
| | | | | | | | - Murray B Stein
- University of California, San Diego, La Jolla.,Veterans Affairs San Diego Healthcare System, San Diego, California
| | | | | | - Claudia S Robertson
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | | | | | | | | | - Kim Boase
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | | | - Randall Chesnut
- Department of Neurological Surgery, University of Washington, Seattle
| | | | | | | | | | - V Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond
| | - Adam Ferguson
- Department of Neurological Surgery, University of California, San Francisco
| | | | - Raquel Gardner
- Department of Neurology, University of California, San Francisco
| | | | | | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Sonia Jain
- University of California, San Diego, La Jolla
| | - Frederick Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | - Joel Kramer
- Department of Neurology, University of California, San Francisco
| | | | - Chris Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joan Machamer
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Christopher Madden
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Alastair Martin
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Randall Merchant
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond
| | - Florence Noel
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Eva Palacios
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Daniel Perl
- Department of Pathology, Uniformed Services University, Bethesda, Maryland
| | - Ava Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Miri Rabinowitz
- Department of Neurology, University of Pennsylvania, Philadelphia
| | | | - Angelle Sander
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Gabriela Satris
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - David Schnyer
- Department of Psychology, University of Texas at Austin, Austin
| | | | | | - Sabrina Taylor
- Department of Neurological Surgery, University of California, San Francisco
| | - Arthur Toga
- University of Southern California, Los Angeles
| | - Alex Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond
| | - Mary J Vassar
- Department of Neurological Surgery, University of California, San Francisco.,Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Paul Vespa
- Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles
| | - Kevin Wang
- Department of Psychiatry, University of Florida, Gainesville
| | - John K Yue
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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17
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Gang MC, Hong KJ, Shin SD, Song KJ, Ro YS, Kim TH, Park JH, Jeong J. New prehospital scoring system for traumatic brain injury to predict mortality and severe disability using motor Glasgow Coma Scale, hypotension, and hypoxia: a nationwide observational study. Clin Exp Emerg Med 2019; 6:152-159. [PMID: 31261485 PMCID: PMC6614045 DOI: 10.15441/ceem.18.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/03/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Assessing the severity of injury and predicting outcomes are essential in traumatic brain injury (TBI). However, the respiratory rate and Glasgow Coma Scale (GCS) of the Revised Trauma Score (RTS) are difficult to use in the prehospital setting. This investigation aimed to develop a new prehospital trauma score for TBI (NTS-TBI) to predict mortality and disability. METHODS We used a nationwide trauma database on severe trauma cases transported by fire departments across Korea in 2013 and 2015. NTS-TBI model 1 used systolic blood pressure <90 mmHg, peripheral capillary oxygen saturation <90% measured via pulse oximeter, and motor component of GCS. Model 2 comprised variables of model 1 and age >65 years. We assessed discriminative power via area under the curve (AUC) value for in-hospital mortality and disability defined according to the Glasgow Outcome Scale with scores of 2 or 3. We then compared AUC values of NTS-TBI with those of RTS. RESULTS In total, 3,642 patients were enrolled. AUC values of NTS-TBI models 1 and 2 for mortality were 0.833 (95% confidence interval [CI], 0.815 to 0.852) and 0.852 (95% CI, 0.835 to 0.869), respectively, while AUC values for disability were 0.772 (95% CI, 0.749 to 0.796) and 0.784 (95% CI, 0.761 to 0.807), respectively. AUC values of NTS-TBI model 2 for mortality and disability were higher than those of RTS (0.819 and 0.761, respectively) (P<0.01). CONCLUSION Our NTS-TBI model using systolic blood pressure, motor component of GCS, oxygen saturation, and age was feasible for prehospital care and showed outstanding discriminative power for mortality.
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Affiliation(s)
- Min Chul Gang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Tae Han Kim
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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18
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Stein MB, Jain S, Giacino JT, Levin H, Dikmen S, Nelson LD, Vassar MJ, Okonkwo DO, Diaz-Arrastia R, Robertson CS, Mukherjee P, McCrea M, Mac Donald CL, Yue JK, Yuh E, Sun X, Campbell-Sills L, Temkin N, Manley GT, Adeoye O, Badjatia N, Boase K, Bodien Y, Bullock MR, Chesnut R, Corrigan JD, Crawford K, Diaz-Arrastia R, Dikmen S, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson A, Foreman B, Gardner R, Gaudette E, Giacino JT, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Jain S, Korley F, Kramer J, Kreitzer N, Levin H, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, McCrea M, Merchant R, Mukherjee P, Nelson LD, Noel F, Okonkwo DO, Palacios E, Perl D, Puccio A, Rabinowitz M, Robertson CS, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Sherer M, Stein MB, Taylor S, Toga A, Temkin N, Valadka A, Vassar MJ, Vespa P, Wang K, Yue JK, Yuh E, Zafonte R. Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study. JAMA Psychiatry 2019; 76:249-258. [PMID: 30698636 PMCID: PMC6439818 DOI: 10.1001/jamapsychiatry.2018.4288] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. OBJECTIVE To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). DESIGN, SETTING, AND PARTICIPANTS Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study. MAIN OUTCOMES AND MEASURES Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. RESULTS Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P < .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P = .03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. CONCLUSIONS AND RELEVANCE After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention.
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Affiliation(s)
- Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla,Department of Family Medicine & Public Health, University of California San Diego, La Jolla,VA San Diego Healthcare System, San Diego, California
| | - Sonia Jain
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla
| | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Lindsay D. Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | - Mary J. Vassar
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Neurological Surgery, University of California, San Francisco
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Claudia S. Robertson
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Pratik Mukherjee
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Radiology & Biomedical Imaging, University of California, San Francisco,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | | | - John K. Yue
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Esther Yuh
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Radiology & Biomedical Imaging, University of California, San Francisco,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Xiaoying Sun
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla
| | | | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle,Department of Biostatistics, University of Washington, Seattle
| | - Geoffrey T. Manley
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Neurological Surgery, University of California, San Francisco
| | | | | | | | - Kim Boase
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | | | - Randall Chesnut
- Department of Neurological Surgery, University of Washington, Seattle
| | | | | | | | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | | | - V Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond
| | - Adam Ferguson
- Department of Neurological Surgery, University of California, San Francisco
| | | | - Raquel Gardner
- Department of Neurology, University of California, San Francisco
| | | | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | | | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Sonia Jain
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla
| | - Frederick Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | - Joel Kramer
- Department of Neurology, University of California, San Francisco
| | | | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Chris Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joan Machamer
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Christopher Madden
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Alastair Martin
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | - Randall Merchant
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond
| | - Pratik Mukherjee
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.,Department of Radiology & Biomedical Imaging, University of California, San Francisco.,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | - Florence Noel
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eva Palacios
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Daniel Perl
- Department of Pathology, Uniformed Services University, Bethesda, Maryland
| | - Ava Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Miri Rabinowitz
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Claudia S Robertson
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | - Angelle Sander
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Gabriela Satris
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - David Schnyer
- Department of Psychology, University of Texas at Austin, Austin
| | | | | | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla.,Department of Family Medicine & Public Health, University of California San Diego, La Jolla.,VA San Diego Healthcare System, San Diego, California
| | - Sabrina Taylor
- Department of Neurological Surgery, University of California, San Francisco
| | - Arthur Toga
- University of Southern California, Los Angeles
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle.,Department of Biostatistics, University of Washington, Seattle
| | - Alex Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond
| | - Mary J Vassar
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco
| | - Paul Vespa
- Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles
| | - Kevin Wang
- Department of Psychiatry, University of Florida, Gainesville
| | - John K Yue
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Esther Yuh
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.,Department of Radiology & Biomedical Imaging, University of California, San Francisco.,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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Kwan V, Vo M, Noel M, Yeates K. A Scoping Review of Pain in Children after Traumatic Brain Injury: Is There More Than Headache? J Neurotrauma 2018; 35:877-888. [PMID: 29207908 DOI: 10.1089/neu.2017.5281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Headache is a common source of pain in children after traumatic brain injury (TBI); however, relatively little is known about nonheadache pain in this pediatric population. The present review seeks to map the extant literature to determine the prevalence, characteristics, and impact of nonheadache pain in children post-TBI of all severities. We found that of 109 studies published on pain in children after a TBI, 95 (87%) were focused exclusively on headache pain and only 14 (13%) reported on nonheadache pain or overall pain, with half (n = 7) in the form of case studies. Overall, the level of evidence was low, with only three level 1 high-quality prospective studies. In one study, over half (57.1%) of adolescents who experienced persistent pain post-TBI reported pain in multiple body sites (e.g., back, lower limb, and neck).1 For each additional noncephalic pain site, the risk for developing chronic migraine is also increased. Nevertheless, pain in body regions other than the head is often not assessed systematically in pediatric TBI research. Findings of the current review suggest that pain assessment in children post-TBI needs improvement, given that pain is linked to worse recovery, poorer quality of life, and can be long-lasting. More rigorous examination of nonheadache pain and its role in impeding recovery in children post-TBI is imperative and has the potential to improve the care and management of children with TBI. We conclude with recommendations for pain assessment, discuss gaps in the literature, and highlight directions for future research.
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Affiliation(s)
- Vivian Kwan
- University of Calgary, Calgary, Alberta, Canada
| | - Mai Vo
- University of Alberta, Edmonton, Alberta, Canada
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Roden-Foreman K, Robinson R, Bennett M, Roaten K, Petrey L, Powers MB, Warren AM. Posttraumatic growth in a heterogeneous sample of traumatically injured patients 1 year postinjury. J Clin Psychol 2017; 74:989-1003. [PMID: 29193058 DOI: 10.1002/jclp.22563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/05/2017] [Accepted: 09/21/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Posttraumatic growth (PTG) describes positive change resulting from challenging life events. The current study examined factors associated with PTG in traumatically injured patients 1 year postinjury. METHOD Participants (N = 221) in this prospective cohort study included adults admitted to a Level I trauma center. Over half the participants (60%) were male, with a mean age of 47. Participants completed baseline measures during hospitalization. PTG was assessed at 12-month follow-up. RESULTS Greater PTG was associated with minority race/ethnicity, lower income, automotive collision, and premorbid psychological disorder other than depression or posttraumatic stress (PTS). These variables are also known to predict PTS in trauma patients. Analysis confirmed that greater PTS at follow-up was associated with more growth. CONCLUSION Participants with the most growth also experienced the most distress. This finding demonstrates the importance of implementing psychological screening and intervention for trauma patients in the acute care setting to reduce PTS and facilitate growth.
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