Zatzick Douglas F, Kang Sun-Mee, Müller Hans-Georg, Russo Joan E, Rivara Frederick P, Katon Wayne, Jurkovich Gregory J, Roy-Byrne Peter
Department of Psychiatry, University of California-Davis, USA.
Am J Psychiatry. 2002 Jun;159(6):941-6. doi: 10.1176/appi.ajp.159.6.941.
Each year approximately 2.5 million Americans are hospitalized after sustaining traumatic physical injuries. Few investigations have comprehensively screened for posttraumatic symptomatic distress or identified predictors of posttraumatic stress disorder (PTSD) in representative samples of surgical inpatients.
The subjects were 101 randomly selected survivors of motor vehicle crashes or assaults who were interviewed while hospitalized and 1, 4, and 12 months after injury. In the surgical ward, inpatients were screened for PTSD, depressive, and dissociative symptoms, for prior trauma, for pre-event functioning, and for alcohol and drug intoxication. Patient demographic and injury characteristics were also recorded. Random coefficient regression models were used to assess the association between these clinical, injury, and demographic characteristics and PTSD symptom levels over the year after the injury.
Of the 101 surgical inpatients, 73% screened positive for high levels of symptomatic distress and/or substance intoxication. At 1, 4, and 12 months after the injury, 30%-40% reported symptoms consistent with a diagnosis of PTSD. High ward PTSD symptom levels were the strongest and most parsimonious predictor of persistent symptoms over the course of the year. Greater prior trauma, stimulant intoxication, and female gender were also associated with higher symptom levels. Increasing injury severity, however, was not associated with higher PTSD symptom levels.
Clinical and demographic characteristics readily identifiable at the time of surgical inpatient hospitalization predict PTSD symptoms over the year after injury. Effectiveness trials that test screening and intervention procedures for at-risk inpatients should be developed.
每年约有250万美国人在遭受身体创伤后住院。很少有研究在外科住院患者的代表性样本中全面筛查创伤后症状困扰或确定创伤后应激障碍（PTSD）的预测因素。
研究对象为101名随机选取的机动车碰撞或袭击幸存者，在其住院期间以及受伤后1个月、4个月和12个月进行访谈。在外科病房，对住院患者进行PTSD、抑郁和解离症状筛查，了解既往创伤、伤前功能以及酒精和药物中毒情况。还记录了患者的人口统计学和损伤特征。使用随机系数回归模型评估这些临床、损伤和人口统计学特征与受伤后一年中PTSD症状水平之间的关联。
101名外科住院患者中，73%筛查出有高水平的症状困扰和/或物质中毒。在受伤后1个月、4个月和12个月，30%-40%的患者报告有符合PTSD诊断的症状。病房中较高的PTSD症状水平是一年中持续症状最强且最简约的预测因素。更多的既往创伤、兴奋剂中毒和女性性别也与较高的症状水平相关。然而，损伤严重程度增加与较高的PTSD症状水平无关。
外科住院患者住院时易于识别的临床和人口统计学特征可预测受伤后一年中的PTSD症状。应开展针对高危住院患者筛查和干预程序的有效性试验。
