Predictors of acute posttraumatic stress disorder symptoms following civilian trauma

Alarcon, Louis H.; Germain, Anne; Clontz, Amy; Roach, Eileen; Nicholas, Dederia H.; Zenati, Mazen S.; Peitzman, Andrew B.; Sperry, Jason L.

doi:10.1097/ta.0b013e31824416aa

Cited by 42 publications

(46 citation statements)

References 32 publications

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“…Our findings are consistent with the existing literature on PTSD predictors suggesting younger age (Alarcon et al, 2012; Chiu, deRoon-Cassini, & Brasel, 2011), depression (O’Donnell, Creamer, & Pattison, 2004; Shalev et al, 1998), number of premorbid psychiatric disorders (Nickel & Egle, 2006), gunshot wounds/penetrating injuries (Alarcon et al, 2012), auto vs. pedestrian accidents (Alarcon et al, 2012), and alcohol use (McFarlane et al, 2009) are all risk factors for PTSD. However, after controlling for PTSD symptoms at the time of admission, only age, number of premorbid psychiatric disorders, and gunshot wounds remained as significant predictors of later PTSD.…”

Section: Discussionsupporting

confidence: 92%

“…gender, ethnicity, education, income, work status, injury severity score, Glasgow coma scale, social support, resilience, marital status, and ICU length of stay). However, these variables were identified as risk factors in previous reports (Alarcon et al, 2012; Chiu et al, 2011; Clapp & Gayle Beck, 2009; Daniels et al, 2012; Harris, Young, Rae, Jalaludin, & Solomon, 2008; O’Donnell, Creamer, Holmes, et al, 2010; O’Donnell, Creamer, McFarlane, Silove, & Bryant, 2010; Peris et al, 2011; Richter, Waydhas, & Pajonk, 2006). Among the possible explanations for the discrepancy in these findings are differences in patient samples, settings, and control features including the novel analysis strategies (i.e.…”

Section: Discussionmentioning

confidence: 83%

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Predictors of PTSD symptoms in adults admitted to a Level I trauma center: A prospective analysis

Powers

Warren

Rosenfield

et al. 2014

Journal of Anxiety Disorders

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Trauma centers are an ideal point of intervention in efforts to prevent posttraumatic stress disorder (PTSD). In order to assist in the development of prevention efforts, this study sought to identify early predictors of PTSD symptoms among adults admitted to a Level I trauma center using a novel analytic strategy (Fournier et al., 2009). Upon admission, participants (N=327) were screened for PTSD symptoms and provided information on potential predictor variables. Their PTSD symptoms were assessed again three months later (N=227). Participants were classified as: symptomatic (positive PTSD screen) or asymptomatic (negative PTSD screen) at the follow-up assessment. Multinomial logistic regression showed that, age, depression, number of premorbid psychiatric disorders, gunshot wound, auto vs. pedestrian accident, and alcohol use predicted who had PTSD symptoms at FU with 76.3% accuracy. However, when controlling for PTSD severity at baseline, only age, number of premorbid psychiatric disorders, and gunshot wounds predicted PTSD symptoms at FU but with 78.5% accuracy. These findings suggest that psychological prevention efforts in trauma centers may be best directed toward adults who are young, have premorbid psychiatric disorders, and those admitted with gunshot wounds.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 83%

Predictors of PTSD symptoms in adults admitted to a Level I trauma center: A prospective analysis

Powers

Warren

Rosenfield

et al. 2014

Journal of Anxiety Disorders

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“…34 In a recent prospective study of 1,386 trauma patients seen in follow-up, more than 40% of those treated after a violent assault experienced symptoms of posttraumatic stress. 35 While it is unclear how many patients or family members in our study were experiencing posttraumatic stress, the recent exposure to violence may have negatively impacted their sense of trust as well as their support of EFIC. Further research investigating the impact of posttraumatic stress on attitudes about emergency research may provide useful insight regarding how to conduct meaningful community consultation with this vulnerable population.…”

Section: Discussionmentioning

confidence: 87%

Exception from informed consent for emergency research

Sims

Isserman

Holena

et al. 2013

Journal of Trauma and Acute Care Surgery

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BACKGROUND Research investigating the resuscitation and management of unstable trauma patients is necessary to improve care and save lives. Because informed consent for research is impossible in emergencies, the Federal Drug Administration has established an Exception from Informed Consent (EFIC) Policy that mandates “community consultation” as a means of protecting patient autonomy. We hypothesized that the trauma community represents a heterogeneous population whose attitudes regarding EFIC and willingness to participate in emergency research are influenced by status as a patient, family, or geographic community member. METHODS In the context of an upcoming trial, trauma patients as well as family and community members were asked to rank statements regarding EFIC and willingness to participate in emergency research using a 5-point Likert-type scale. Higher total scores reflected a more positive attitude regarding EFIC (range, 4–20; neutral = 12) and willingness (range, 21–105, neutral = 63). The influence of demographics, education, and interpersonal violence were evaluated by Kruskal-Wallis and Mann-Whitney U-tests (p < 0.05). RESULTS Overall, the 309 participants (trauma patients, n = 172; family, n = 73; community, n = 64) were positive about EFIC (median, 16; interquartile range, [IQR], 14–18) and demonstrated high willingness scores (median, 82; IQR, 76–88.5). EFIC and willingness were not influenced by age, sex, race, or education. Victims of interpersonal violence and their family members had lower EFIC scores than those with other mechanisms (median [IQR], 16 [14–18] vs. 16 [13–16]; p = 0.04) but similar willingness. Although EFIC scores were similar between groups, trauma patients had significantly lower willingness than family (median [IQR], 74 [68–77] vs. 77 [70–85]; p = 0.03) or community members (median [IQR], 76 [70–84]; p = 0.01). CONCLUSION Trauma patients, families, and the geographic community expressed a high degree of support for EFIC and willingness to participate in emergency research, although support was influenced by injury mechanism and group status. Consultation efforts for emergency research should extend beyond the geographic community to include trauma victims and their families. LEVEL OF EVIDENCE Epidemiologic, level III.

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“…The Pearson product-moment correlation (r) was used to determine the strength and direction of the relation between acute posttraumatic risk markers and PTSD symptoms or disorder. For studies reporting data for pairings of continuous and dichotomous variables, including presence or absence of PTSD diagnosis at follow-up (Bryant et al, 2008; Coronas et al, 2011; De Young et al, 2007; Shalev & Freedman, 2005; Videlock et al, 2008; Yehuda et al, 1998), PTSD symptom cutoff scores (Alarcon et al, 2011; Gould et al, 2011), or cut-off scores for risk markers (Bryant et al, 2008; Zatzick et al, 2005), formulas were used to impute point-biserial correlations (Lipsey & Wilson, 2001). All r values were transformed using the Fisher’s Z r transform (Hedges & Olkin, 1985) and associated standard errors and inverse variance weights were computed for each effect size.…”

Section: Methodsmentioning

confidence: 99%

Cortisol, heart rate, and blood pressure as early markers of PTSD risk: A systematic review and meta-analysis

Morris

Hellman

Abelson

et al. 2016

Clinical Psychology Review

116

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Individuals with posttraumatic stress disorder (PTSD) typically exhibit altered hypothalamic-pituitary-adrenal (HPA) function and sympathetic nervous system (SNS) activity. The goals of this study were to determine whether HPA and SNS alterations in the immediate aftermath of trauma predict subsequent PTSD symptom development and whether inconsistencies observed between studies can be explained by key demographic and methodological factors. This work informs secondary prevention of PTSD by identifying subgroups of trauma survivors at risk for PTSD. This meta-analysis (26 studies, N = 5,186 individuals) revealed that higher heart rate measured soon after trauma exposure was associated with higher PTSD symptoms subsequently (r = .13). Neither cortisol (r = −.07) nor blood pressure (diastolic: r = −.01; systolic: r = .02) were associated with PTSD symptoms which may be influenced by methodological limitations. Associations between risk markers (heart rate, cortisol, systolic blood pressure) and PTSD symptoms were in the positive direction for younger samples and negative direction for older samples. These findings extend developmental traumatology models of PTSD by revealing an age-related shift in the presentation of early risk markers. More work will be needed to identify risk markers and pathways to PTSD while addressing methodological limitations in order to shape and target preventive interventions.

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Predictors of acute posttraumatic stress disorder symptoms following civilian trauma

Abstract: II.

Cited by 42 publications

References 32 publications

Predictors of PTSD symptoms in adults admitted to a Level I trauma center: A prospective analysis

Predictors of PTSD symptoms in adults admitted to a Level I trauma center: A prospective analysis

Exception from informed consent for emergency research

Cortisol, heart rate, and blood pressure as early markers of PTSD risk: A systematic review and meta-analysis

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