Visser Eva, Gosens Taco, Den Oudsten Brenda Leontine, De Vries Jolanda
From the Trauma TopCare (E.V.), Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands; Department of Orthopaedics (T.G.), Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology (B.L.D.O., J.D.V.), Tilburg University, Tilburg, The Netherlands; and Department of Medical Psychology (J.D.V.), Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
J Trauma Acute Care Surg. 2017 Jun;82(6):1158-1183. doi: 10.1097/TA.0000000000001447.
Trauma patients suffer from acute stress disorder (ASD) and posttraumatic stress disorder (PTSD), but it is unknown how these disorders develop over time and when treatment is effective. Our aim was to systematically review (1) the course and predictors of ASD and PTSD after trauma and (2) which and when psychological treatments are effective.
Embase, Medline, Web of Science, Scopus, PsycInfo, Cinahl, Cochrane, PubMed, and Google Scholar were searched up to September 14, 2015. Quality was assessed with STROBE and CONSORT checklists.
Overall, 45 (68%) observational studies and 21 (32%) intervention studies were included. Forty-seven (85%) were of lower (level of evidence (LoE) 3) or poor quality (LoE 4). ASD was found during hospitalization (range 1-37%) and about 30% experienced PTSD 1 month after trauma (LoE 3). The onset of PTSD was within 3 months but also up to 12 months after trauma (LoE 3). Especially in patients with ASD, patients showed PTSD symptoms after 6 years (LoE 3). ASD and PTSD were associated with sociodemographic factors (e.g., being female, younger age, financial problems, and low income), reduced cognitive functioning, and physical (e.g., pain), social (e.g., low social support), and psychological problems (e.g., hyperarousal) or disorders (e.g., ASD). Early treatment in the first weeks after trauma can be preventive for PTSD, but effective treatment for ASD is still unclear. Compared to other psychological treatments, the most effective and examined treatment for PTSD was cognitive behavioral therapy (CBT).
A large number of studies of lower or poor quality present inconsistent findings on the course of ASD and PTSD. Predictors for ASD and PTSD were identified. Early treatment can be preventive for PTSD, as CBT is the most effective treatment. However, good qualitative observational and intervention studies are lacking and needed.
Systematic review, level III.
创伤患者会遭受急性应激障碍（ASD）和创伤后应激障碍（PTSD），但尚不清楚这些障碍如何随时间发展以及治疗何时有效。我们的目的是系统评价：（1）创伤后ASD和PTSD的病程及预测因素；（2）哪些心理治疗有效以及何时有效。
检索截至2015年9月14日的Embase、Medline、科学引文索引、Scopus、心理学文摘数据库、护理学与健康领域数据库、考克兰图书馆、PubMed和谷歌学术。采用加强流行病学观察性研究报告规范（STROBE）和随机对照试验报告统一标准（CONSORT）清单评估质量。
总体上，纳入了45项（68%）观察性研究和21项（32%）干预性研究。47项（85%）研究证据等级较低（证据等级3级）或质量较差（证据等级4级）。住院期间发现ASD的比例为1%至37%，约30%的患者在创伤后1个月出现PTSD（证据等级3级）。PTSD的发病在创伤后3个月内，但也可能长达12个月（证据等级3级）。特别是ASD患者，6年后仍表现出PTSD症状（证据等级3级）。ASD和PTSD与社会人口学因素（如女性、年龄较小、经济问题和低收入）、认知功能下降以及身体（如疼痛）、社会（如社会支持低）和心理问题（如过度觉醒）或障碍（如ASD）相关。创伤后最初几周的早期治疗可预防PTSD，但ASD的有效治疗仍不明确。与其他心理治疗相比，对PTSD最有效且经过检验的治疗方法是认知行为疗法（CBT）。
大量质量较低或较差的研究对ASD和PTSD的病程得出了不一致的结果。确定了ASD和PTSD的预测因素。早期治疗可预防PTSD，因为CBT是最有效的治疗方法。然而，缺乏且需要高质量的观察性和干预性研究。
系统评价，三级。
