Konrad Beatrice, Hiti David, Chang Bernard P, Retuerto Jessica, Julian Jacob, Edmondson Donald
Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St, PH9-317, New York, NY, 10032, USA.
Division of Emergency Medicine, Columbia University Medical Center, New York Presbyterian Hospital, 622 West 168th Street, New York, NY, 10032, USA.
BMC Emerg Med. 2017 Nov 6;17(1):33. doi: 10.1186/s12873-017-0144-3.
As many as 12% of acute coronary syndrome (ACS) patients screen positive for post-traumatic stress disorder (PTSD) symptoms due to their cardiac event, and emergency department (ED) factors such as overcrowding have been associated with risk for PTSD. We tested the association of patients' perceptions of their proximity to a critically ill patient during ED evaluation for ACS with development of posttraumatic stress symptoms (PSS) in the month after hospital discharge.
Participants were enrolled in the REactions to Acute Care and Hospitalization (REACH) study during evaluation for ACS in an urban ED. Participants reported whether they perceived a patient near them was close to death. They also reported their current fear, concern they may die, perceived control, and feelings of vulnerability on an Emergency Room Perceptions questionnaire. One month later, participants reported on PTSD symptoms specific to the cardiac event and ED hospitalization.
Of 763 participants, 12% reported perceiving a nearby patient was likely to die. In a multivariate linear regression model [F(9757) = 19.69, p < .001, R adjusted = .18] with adjustment for age, sex, GRACE cardiac risk score, discharge ACS diagnosis, Charlson comorbidity index, objective ED crowding, and depression symptoms at baseline, perception of a nearby patients' likely death was associated with a 2.33 point (95% CI, 0.60-4.61) increase in 1 month PTSD score. A post hoc mediation analysis with personal threat perceptions [F(10,756) = 25.28, p < .001, R adjusted = .24] showed increased personal threat perceptions during the ED visit, B = 0.71 points on the PCL per point on the personal threat perception questionnaire, β = 0.27, p = .001, fully mediated association of participants' perceptions of nearby patients' likely death with 1-month PTSD score (after adjustment for ED threat perceptions,) B = 0.89 (95% CI, -1.33 to 3.12), β = 0.03, p = .43, accounting for 62% of the adjusted effect and causing the main effect to become statistically nonsignificant.
We found patients who perceived a nearby patient was likely to die had significantly greater PTSD symptoms at 1 month. Awareness of this association may be helpful for designing ED patient management procedures to identify and treat patients with an eye to post-ACS psychological care.
高达12%的急性冠状动脉综合征（ACS）患者因心脏病事件而筛查出创伤后应激障碍（PTSD）症状呈阳性，而急诊科（ED）的因素如过度拥挤与PTSD风险相关。我们测试了在急诊科对ACS进行评估期间，患者对自己与危重症患者接近程度的感知与出院后一个月内创伤后应激症状（PSS）发生之间的关联。
参与者在城市急诊科对ACS进行评估期间被纳入急性护理和住院反应（REACH）研究。参与者报告他们是否感觉到附近的患者濒临死亡。他们还在急诊室感知问卷上报告了他们当前的恐惧、对自己可能死亡的担忧、感知到的控制以及脆弱感。一个月后，参与者报告了与心脏事件和急诊科住院相关的PTSD症状。
在763名参与者中，12%报告感觉到附近的患者可能死亡。在一个多变量线性回归模型[F(9757) = 19.69，p <.001，调整后R =.18]中，对年龄、性别、GRACE心脏风险评分、出院时的ACS诊断、Charlson合并症指数、急诊科客观拥挤程度以及基线时的抑郁症状进行调整后，对附近患者可能死亡的感知与1个月PTSD评分增加2.33分（95%CI，0.60 - 4.61）相关。一项事后中介分析，采用个人威胁感知[F(10,756) = 25.28，p <.001，调整后R =.24]，结果显示在急诊科就诊期间个人威胁感知增加，个人威胁感知问卷上每增加1分，PCL上增加0.71分，β = 0.27，p =.001，参与者对附近患者可能死亡的感知与1个月PTSD评分之间的关联完全由中介效应介导（在对急诊科威胁感知进行调整后），B = 0.89（95%CI，-1.33至3.12），β = 0.03，p =.43，占调整后效应的62%，并使主效应在统计学上变得不显著。
我们发现感觉到附近患者可能死亡的患者在1个月时PTSD症状明显更严重。认识到这种关联可能有助于设计急诊科患者管理程序，以便在关注ACS后心理护理的同时识别和治疗患者。
