Predictive Factors for Acute Stress Disorder and Posttraumatic Stress Disorder after Motor Vehicle Accidents

Yaşan, Aziz; Güzel, Aslan; Tamam, Yusuf; Özkan, Mustafa

doi:10.1159/000218521

Cited by 33 publications

(17 citation statements)

References 47 publications

(43 reference statements)

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“…Posttraumatic stress disorder (PTSD) is another common and morbid health problem resulting from MVC [ 31 ], and the initial psychological response to MVC is an important indicator of PTSD risk following MVC [ 32 - 34 ]. PTSD is also known to be prevalent in approximately 1% of older adults [ 35 ], and advanced age may exacerbate symptoms of PTSD [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

et al. 2014

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BackgroundMotor 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.MethodsIn-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.ResultsOlder (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.ConclusionsIn 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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Section: Discussionmentioning

confidence: 99%

Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

et al. 2014

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“…A substantial share of studies that investigated prevalence rates and predictors of PTSD following injury addressed certain injury subgroups, such as victims of motor vehicle accidents [4-7], burn victims [8-10] or patients who required admission to hospital or the Intensive Care Unit [3,11-15]. Those previous studies were mainly conducted in clinical patient populations and were therefore restricted to accidents and injuries at the higher end of the severity spectrum.…”

Section: Introductionmentioning

confidence: 99%

Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department

et al. 2012

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BackgroundAmong injury victims relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. PTSD is associated with functional impairments and decreased health-related quality of life (HRQoL). Previous studies that addressed the latter were restricted to injuries at the higher end of the severity spectrum. This study examined the association between PTSD symptoms and health-related quality of life (HRQoL) in a comprehensive population of injury patients of all severity levels and external causes.MethodsWe conducted a self-assessment survey which included items regarding demographics of the patient, accident type, sustained injuries, EuroQol health classification system (EQ-5D) and Health Utilities Index (HUI) to measure functional outcome and HRQoL, and the Impact of Event Scale (IES) to measure PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of PTSD. The survey was completed by 1,781 injury patients two years after they were treated at the Emergency Department (ED), followed by either hospital admission or direct discharge to the home environment.ResultsSymptoms indicative of PTSD were associated with more problems on all EQ-5D and HUI3 domains of functional outcome and a considerable utility loss in both hospitalized (0.23-0.24) and non-hospitalized (0.32-0.33) patients. Differences in reported problems between patients with IES scores higher or lower than 35 were largest for EQ-5D health domains pain/discomfort (82% versus 28%) and anxiety/depression (53% versus 11%) and HUI domains emotion (92% versus 33%) and pain (84% versus 38%). After adjusting for potential confounders, PTSD remained strongly associated with adverse HRQoL.ConclusionsAmong patients treated at an ED posttraumatic stress symptoms indicative of PTSD were associated with a considerable decrease in HRQoL in both hospitalized and non-hospitalized patients. PTSD symptoms may therefore raise a major barrier for full recovery of injury patients of even minor levels of severity.

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“…Data from WHO demonstrated that 20 to 50 million people are injured or disabled in road collisions over the course of one year [2]. These accidents are frequently followed by PTSD at about six months in 8.5–23.1% of victims [3,4]. However, many victims do not develop the symptoms that qualify them for the diagnosis of PTSD.…”

Section: Introductionmentioning

confidence: 99%

Alterations in White Matter Microstructure as Vulnerability Factors and Acquired Signs of Traffic Accident-Induced PTSD

et al. 2013

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It remains unclear whether white matter (WM) changes found in post-traumatic stress disorder (PTSD) patients are stress-induced or precursors for vulnerability. The current study aimed to identify susceptibility factors relating to the development of PTSD and to examine the ability of these factors to predict the course of longitudinal PTSD. Sixty two victims who had experienced traffic accidents underwent diffusion tensor imaging using a 3.0T MRI system within 2 days after their accidents. Of these, 21 were diagnosed with PTSD at 1 or 6 months using the Clinician-Administered Ptsd Scale (CAPS). Then, 11 trauma-exposed victims with PTSD underwent the second MRI scan. Compared with the victims without PTSD, the victims with PTSD showed decreased fractional anisotropy (FA) in WM of the anterior cingulate cortex, ventromedial prefrontal cortex (vmPFC), temporal lobes and midbrain, and increased mean diffusivity (MD) in the vmPFC within 2 days after the traumatic event. Importantly, decreased FA of the vmPFC in the acute phase predicted greater future CAPS scores. In addition, we found decreased FA in the insula in the follow-up scan in the victims with PTSD, which correlated with the decreased FA of the vmPFC in their baseline scan. These results suggested that the WM might have changed within 2 days after the traumatic event in the individuals who would later develop PTSD. Furthermore, decreased FA of the vmPFC could be a possible vulnerability marker predicting future development of PTSD and may provide an outcome prediction of the acquired signs.

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Predictive Factors for Acute Stress Disorder and Posttraumatic Stress Disorder after Motor Vehicle Accidents

Cited by 33 publications

References 47 publications

Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department

Alterations in White Matter Microstructure as Vulnerability Factors and Acquired Signs of Traffic Accident-Induced PTSD

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