Holbrook T L, Hoyt D B, Stein M B, Sieber W J
Department of Family and Preventive Medicine, University of California, San Diego, California, USA.
J Trauma. 2001 Aug;51(2):287-92; discussion 292-3. doi: 10.1097/00005373-200108000-00010.
The importance of psychological morbidity after major trauma, such as posttraumatic stress disorder (PTSD), is continuing to gain attention in trauma outcomes research. The Trauma Recovery Project is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL) and PTSD. The specific objectives of the present report are to examine risk factors for PTSD and to assess the impact on QoL at the 6-, 12-, and 18-month follow-up time points in the Trauma Recovery Project population.
Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay > 24 hours. QoL was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Early symptoms of acute stress reaction (SASR) at discharge were assessed using the Impact of Events Scale (score > 30 = SASR). PTSD at 6-month follow-up was diagnosed using standardized Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge.
PTSD was diagnosed in 32% (261 of 824) patients at 6-month follow-up. Perceived threat to life predicted PTSD onset (odds ratio [OR], 1.6; p < 0.01) and early SASR (OR, 2.2; p < 0.001). PTSD was more frequent in women (39%) than in men (29%) and in younger low-income patients. Other major risk factors were penetrating trauma (OR, 2.3; p < 0.001) and assaults (OR, 1.5; p < 0.05). PTSD had a major impact on QoL at 6-, 12-, and 18-month follow-up (Quality of Well-being scale score: 6 months, 0.576 vs. 0.658; 12 months, 0.620 vs. 0.691; 18 months, 0.620 vs. 0.700; p < 0.0001).
These results provide new and provocative evidence that perceived threat to life and mechanism predict PTSD after major traumatic injury. PTSD had a prolonged and profound impact on short- and long-term outcome and QoL.
重大创伤后的心理疾病，如创伤后应激障碍（PTSD），在创伤结局研究中日益受到关注。创伤恢复项目是一项大型前瞻性流行病学研究，旨在检查重大创伤后的多种结局，包括生活质量（QoL）和PTSD。本报告的具体目标是在创伤恢复项目人群中，研究PTSD的危险因素，并评估在6个月、12个月和18个月随访时间点对生活质量的影响。
1993年12月1日至1996年9月1日期间，1048名符合条件的创伤患者被分诊到圣地亚哥区域创伤系统的四家参与创伤中心医院，并纳入研究。研究的纳入标准包括年龄18岁及以上、入院时格拉斯哥昏迷量表评分12分或更高，以及住院时间>24小时。受伤后使用幸福感量表测量生活质量，该量表是功能连续体良好结局的敏感指标（范围：0 = 死亡至1.000 = 最佳功能）。出院时使用事件影响量表评估急性应激反应（SASR）的早期症状（评分>30 = SASR）。6个月随访时使用标准化的《精神障碍诊断与统计手册》第4版标准诊断PTSD。在出院时以及出院后6个月、12个月和18个月评估患者结局。
6个月随访时，32%（824名患者中的261名）被诊断为PTSD。对生命的感知威胁可预测PTSD的发生（优势比[OR]，1.6；p < 0.01）和早期SASR（OR，2.2；p < 0.001）。女性（39%）患PTSD的频率高于男性（29%），且在年轻的低收入患者中更常见。其他主要危险因素为穿透性创伤（OR，2.3；p < 0.001）和袭击（OR，1.5；p < 0.05）。PTSD在6个月、12个月和18个月随访时对生活质量有重大影响（幸福感量表评分：6个月，0.576对0.658；12个月，0.620对0.691；18个月，0.620对0.700；p < 0.0001）。
这些结果提供了新的且具有启发性的证据，即对生命的感知威胁和损伤机制可预测重大创伤性损伤后的PTSD。PTSD对短期和长期结局以及生活质量有长期而深远的影响。
