Ahl Rebecka, Lindgren Rickard, Cao Yang, Riddez Louis, Mohseni Shahin
School of Medical Sciences, Orebro University, Orebro, Sweden; Karolinska University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, Stockholm, Sweden.
Orebro University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, Orebro, Sweden.
Injury. 2017 May;48(5):1082-1087. doi: 10.1016/j.injury.2017.03.019. Epub 2017 Mar 19.
A significant proportion of patients suffer depression following traumatic injuries. Once manifested, major depression is challenging to overcome and its presence risks impairing the potential for physical rehabilitation and functional recovery. Risk stratification for early detection and intervention in these instances is important. This study aims to investigate patient and injury characteristics associated with an increased risk for depression.
All patients with traumatic injuries were recruited from the trauma registry of an urban university hospital between 2007 and 2012. Patient and injury characteristics as well as outcomes were collected for analysis. Patients under the age of eighteen, prescribed antidepressants within one year of admission, in-hospital deaths and deaths within 30days of trauma were excluded. Pre- and post-admission antidepressant data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. To isolate independent risk factors for depression a multivariable forward stepwise logistic regression model was deployed.
A total of 5981 patients met the inclusion criteria of whom 9.2% (n=551) developed post-traumatic depression. The mean age of the cohort was 42 [standard deviation (SD) 18] years and 27.1% (n=1620) were females. The mean injury severity score was 9 (SD 9) with 18.4% (n=1100) of the patients assigned a score of at least 16. Six variables were identified as independent predictors for post-traumatic depression. Factors relating to the patient were female gender and age. Injury-specific variables were penetrating trauma and GCS score of≤8 on admission. Furthermore, intensive care admission and increasing hospital length of stay were predictors of depression.
Several risk factors associated with the development of post-traumatic depression were identified. A better targeted in-hospital screening and patient-centered follow up can be offered taking these risk factors into consideration.
相当一部分患者在遭受创伤性损伤后会患上抑郁症。一旦出现重度抑郁症，就很难克服，而且它的存在有可能损害身体康复和功能恢复的潜力。在这些情况下，进行风险分层以早期发现和干预非常重要。本研究旨在调查与抑郁症风险增加相关的患者和损伤特征。
2007年至2012年期间，从一家城市大学医院的创伤登记处招募了所有创伤性损伤患者。收集患者和损伤特征以及结果进行分析。排除18岁以下的患者、入院一年内开具抗抑郁药的患者、住院死亡患者以及创伤后30天内死亡的患者。从国家药物登记处获取入院前和入院后的抗抑郁药数据。创伤后抑郁症定义为创伤后一年内开具抗抑郁药。为了确定抑郁症的独立危险因素，采用了多变量向前逐步逻辑回归模型。
共有5981名患者符合纳入标准，其中9.2%（n =
551）患上了创伤后抑郁症。该队列的平均年龄为42岁[标准差（SD）18]，女性占27.1%（n = 1620）。平均损伤严重程度评分为9分（SD 9），18.4%（n = 1100）的患者评分为至少16分。六个变量被确定为创伤后抑郁症的独立预测因素。与患者相关的因素是女性性别和年龄。与损伤相关的变量是穿透性创伤和入院时格拉斯哥昏迷量表（GCS）评分为≤8分。此外，入住重症监护病房和住院时间延长是抑郁症的预测因素。
确定了几个与创伤后抑郁症发生相关的危险因素。考虑到这些危险因素，可以提供更有针对性的院内筛查和以患者为中心的随访。
