Physical Trauma Patients with Symptoms of an Acute and Posttraumatic Stress Disorder: Protocol for an Observational Prospective Cohort Study (Preprint)

Abstract

Psychological trauma can be divided into Type-I trauma (i.e. one single traumatic event (e.g. car accident)) and Type-II trauma (i.e. repeated and prolonged traumatization (e.g. abuse)). Physical trauma or injury is a Type-I trauma and a major source of high medical and social costs 1 . In the Netherlands, injury is the leading cause of death for persons younger than 35 years old 2 .Due to registration and implementation of specialized trauma care after injury, the quality of trauma care has been improved and survivorship increased [1][2][3][4][5][6] . However, patients go through a process of treatment after injury: from the ambulance or trauma helicopter to the shock room, possible hospital stay, and finally rehabilitation. The treatment in, for example, the shock room can be impressive and can have a major impact on patients' wellbeing. About 43% to 84% of the patients experience psychological problems (e.g. anxiety, depressive symptoms or opioid abuse) 7-10 and 7% has psychiatric comorbidity after physical trauma 11 . About 25% of the trauma patients have an (subsyndromal) acute stress disorder (ASD) during hospitalization and about 30% had post-traumatic stress disorder (PTSD) one month after injury 12,13 . About 49% showed a delayed onset of PTSD six months after injury. This percentage decreased to 20% at 24 months after injury 13 . Diagnostic criteria for ASD and PTSD are similar with regard to re-experiencing (e.g. flashbacks), increased arousal (e.g. difficulty concentrating), and persistent avoidance (e.g. efforts to avoid thoughts, feelings or places associated with the trauma). However, dissociative symptoms (e.g., numbing, reduction in awareness of surroundings, depersonalization, derealization, and/or dissociative amnesia) are emphasized in ASD, while PTSD does not include dissociative symptoms. Moreover, the diagnosis ASD can only be given within the first month after a traumatic event and last for less than a month. If the symptoms continue longer than a month, a diagnosis of PTSD is given. The symptoms may begin either after trauma or months or years afterwards 14 . PTSD symptoms persist for at least one month after injury 15 .Psychosocial problems and disorders can have a negative impact on patients' lives up to years later 13,[16][17][18] . For instance, 45% of the patients could not pursue with leisure activities and 27% reported a broken marriage six years after trauma 19 . Furthermore, pain was found to be a major predictor for psychological adjustment problems two years after injury 16 . ASD, PTSD, and psychological distress are positively associated with wound healing and fatigue 13,[20][21][22][23][24][25] and negatively with quality of life (QOL) compared to the general population 18,[26][27][28][29][30][31] . Also, patients' satisfaction with work status, general health, and recovery from injury are related with impaired mental health, depressive symptoms, and increased risk of substance abuse 30,32 . As a result, the costs of care increases due to patients who needs more medical care...