Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury

Abstract

Post-traumatic stress disorder (PTSD) is a condition associated with traumatic brain injury (TBI). While the importance of PTSD and TBI among military personnel is widely recognized, there is less awareness of PTSD associated with civilian TBI. We examined the incidence and factors associated with PTSD 6 months post-injury in a civilian emergency department population using measures from the National Institute of Neurological Disorders and Stroke TBI Common Data Elements Outcome Battery. Participants with mild TBI (mTBI) from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with complete 6-month outcome batteries (n = 280) were analyzed. Screening for PTSD symptoms was conducted using the PTSD Checklist-Civilian Version. Descriptive measures are summarized and predictors for PTSD were examined using logistic regression. Incidence of screening positive for PTSD was 26.8% at 6 months following mTBI. Screening positive for PTSD was significantly associated with concurrent functional disability, post-concussive and psychiatric symptomatology, decreased satisfaction with life, and decreased performance in visual processing and mental flexibility. Multi-variable regression showed injury mechanism of assault (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.69-7.63; p = 0.001) and prior psychiatric history (OR 2.56; 95% CI 1.42-4.61; p = 0.002) remained significant predictors of screening positive for PTSD, while education (per year OR 0.88; 95% CI 0.79-0.98; p = 0.021) was associated with decreased odds of PTSD. Standardized data collection and review of pre-injury education, psychiatric history, and injury mechanism during initial hospital presentation can aid in identifying patients with mTBI at risk for developing PTSD symptoms who may benefit from closer follow-up after initial injury care.

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“…Even patients with mild TBI-who would be considered to have good recovery on the GOSE-often have anxiety, depression, post-traumatic stress disorder, and clinically relevant The Lancet Neurology Commission postconcussion symptoms, including, but not confined to, headache, dizziness or vertigo, fatigue, irritability, disordered sleep, and memory and concentration problems. 111,332,[430][431][432][433] Postconcussion symptoms pose particular challenges for outcome assessment because their occurrence depends on complex interactions between physiological, psychological, and social factors. Furthermore, they are not entirely specific to TBI as they can occur in patients with orthopaedic injuries or in healthy individuals.…”

Preliminary validation of the Dutch version of the Posttraumatic stress disorder checklist for DSM-5 (PCL-5) after traumatic brain injury in a civilian population

“…In military settings, the incidence rate is higher and ranges from 33 to 65% [40,41]. Despite broad ranges of reported incidence rates of PTSD after TBI, PTSD is recognized as an important cause of disability following TBI [42].…”

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“…It is increasingly recognized that mTBI/ concussion can cause long-term consequences, for example, functional deficits limiting return to work, and a variety of neurocognitive and neuropsychiatric symptoms. [14][15][16][17] Recent studies show that up to 80% of patients may experience symptomatology and 30% may be functionally impaired at 3 and 6 months. 18 Lack of health care engagement in the setting of persistent symptoms can present significant challenges to have deleterious impacts to socioeconomic self-sufficiency and cause development of maladaptive coping mechanisms.…”