Roden-Foreman Kenleigh, Solis Jaicus, Jones Alan, Bennett Monica, Roden-Foreman Jacob W, Rainey Evan E, Foreman Michael L, Warren Ann Marie
*Division of Psychology, UT Southwestern Medical Center, Dallas, TX; and †Department of Surgery, Baylor University Medical Center, Dallas, TX.
J Orthop Trauma. 2017 Sep;31(9):e275-e280. doi: 10.1097/BOT.0000000000000884.
Psychological morbidities after injury [eg, posttraumatic stress disorder (PTSD) and depression] are increasingly recognized as a significant determinant of overall outcome. Traumatic brain injury (TBI) negatively impacts outcomes of patients with orthopaedic injury, but the association of concurrent TBI, orthopaedic injury, and symptoms of PTSD and depression has not been examined. This study's objective was to examine symptoms of PTSD and depression in patients with orthopaedic trauma with and without TBI.
Longitudinal prospective cohort study.
Urban Level I Trauma Center in the Southwest United States.
PATIENTS/PARTICIPANTS: Orthopaedic trauma patients older than 18 years admitted for ≥24 hours.
Questionnaires examining demographics, injury-related variables, PTSD, and depression were administered during hospitalization and 3, 6, and 12 months later. Orthopaedic injury and TBI were determined based on ICD-9 codes. Generalized linear models determined whether PTSD and depression at follow-up were associated with TBI.
Of the total sample (N = 214), 44 (21%) sustained a TBI. Those with TBI had higher rates of PTSD symptoms, 12 months postinjury (P = 0.04). The TBI group also had higher rates of depressive symptoms, 6 months postinjury (P = 0.038).
Having a TBI in addition to orthopaedic injury was associated with significantly higher rates of PTSD at 12 months and depression at 6 months postinjury. This suggests that sustaining a TBI in addition to orthopaedic injury places patients at a higher risk for negative psychological outcomes. The findings of this study may help clinicians to identify patients who are in need for psychological screening and could potentially benefit from intervention.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
损伤后的心理疾病（如创伤后应激障碍（PTSD）和抑郁症）越来越被认为是总体预后的重要决定因素。创伤性脑损伤（TBI）对骨科损伤患者的预后产生负面影响，但TBI、骨科损伤以及PTSD和抑郁症症状之间的关联尚未得到研究。本研究的目的是检查有和没有TBI的骨科创伤患者的PTSD和抑郁症症状。
纵向前瞻性队列研究。
美国西南部的城市一级创伤中心。
患者/参与者：年龄大于18岁、住院时间≥24小时的骨科创伤患者。
在住院期间以及3、6和12个月后，发放调查问卷以检查人口统计学、损伤相关变量、PTSD和抑郁症情况。根据国际疾病分类第九版（ICD - 9）编码确定骨科损伤和TBI。广义线性模型确定随访时的PTSD和抑郁症是否与TBI相关。
在总样本（N = 214）中，44例（21%）发生了TBI。TBI患者在受伤后12个月时PTSD症状发生率更高（P = 0.04）。TBI组在受伤后6个月时抑郁症状发生率也更高（P = 0.038）。
除骨科损伤外还发生TBI与受伤后12个月时PTSD发生率显著更高以及6个月时抑郁症发生率显著更高相关。这表明除骨科损伤外还发生TBI会使患者出现负面心理结局的风险更高。本研究结果可能有助于临床医生识别需要进行心理筛查且可能从干预中获益的患者。
预后性三级证据。有关证据水平的完整描述，请参阅作者须知。
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