Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors

Abstract

Objective-To assess intensive care unit (ICU)/acute care service-delivery characteristics and pre-ICU factors as predictors of posttraumatic stress disorder (PTSD) and return to usual major activity after ICU admission for trauma.Method-Data from the National Study on the Costs and Outcomes of Trauma was used to evaluate a prospective cohort of 1,906 ICU survivors. We assessed PTSD with the PTSD Checklist. Regression analyses ascertained associations between ICU/acute care service-delivery characteristics, pre-ICU factors, early post-ICU distress, and 12-month PTSD and return to usual activity, while controlling for clinical and demographic characteristics.Results-Approximately 25% of ICU survivors had symptoms suggestive of PTSD. Increased early post-ICU distress predicted both PTSD and diminished usual major activity. Pulmonary artery Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptGen Hosp Psychiatry. Author manuscript; available in PMC 2010 September 1.

Indicators of injury recovery identified by patients, family members and clinicians

“…Clinicians approach emotional recovery from a more pathological lens, speaking of PTSD and depression, and this is consistent with the preponderance of the current literature 29,30 . Importantly, stakeholder groups differed in their perspectives of recovering emotional stability.…”

Physical Function and Mental Health in Trauma Intensive Care Patients

“…This is particularly important given the differences in baseline characteristics of those retained in the study compared to those who were lost to follow-up (although we attempted to compensate for this loss in our analysis). Although disappointing, this retention rate compares favourably with other similar cohorts, with retention rates ranging from 76% in 1906 patients in the USA (11) and 68% in 332 patients in the Netherlands at 12 months (12) to 41% in 241 patients in the USA at 12 months (68) and 39% in 146 patients in Sweden at 24 months (48). When designing studies to test the effectiveness of interventions designed to improve recovery it is essential to incorporate strategies, and associated funding, for detailed and multi-dimensional follow-up of patients to improve the likelihood of high retention rates.…”

“…Injured patients experience reduced quality of life (4)(5)(6), functional ability (7)(8)(9) and psychological status that is sustained over time (10)(11)(12). Probably as a result of this reduced function, injured patients have a greater ongoing use of health services (13) than others in the community (14).…”

“…Some known predictors of recovery after injury include age, gender, education, injury type and severity, duration of hospitalisation and comorbidities (8,9,11,12,(16)(17)(18)(19), however these factors are generally not modifiable during the initial hospital stay. Initial evidence suggests that potentially modifiable factors such as early post-ICU distress (11), early physical and mental function (20), illness perception (21), self-efficacy (22-24) and depression after hospital discharge (25) may influence recovery, although the latter three factors have only been examined in those with minor or chronic injuries rather than the seriously injured patient population.…”

“…Initial evidence suggests that potentially modifiable factors such as early post-ICU distress (11), early physical and mental function (20), illness perception (21), self-efficacy (22-24) and depression after hospital discharge (25) may influence recovery, although the latter three factors have only been examined in those with minor or chronic injuries rather than the seriously injured patient population. Further, much of the evidence of reduced function during recovery and associated factors has been limited to relatively short time-frames of approximately one year (11,17,19,26). As many of the study participants continued to report reduced function at one year, further examination of longer term outcomes was warranted.…”