From the Department of Trauma (S.H., H.T., F.A., S.T., H.-C.P., R.P.), University Hospital Zurich, University of Zurich, Zurich, Switzerland; Medical University RWTH Aachen (A.T.L.), Aachen, Germany; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine (R.v.K., K.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland; and Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio (B.Z.), San Antonio, Texas.
J Trauma Acute Care Surg. 2019 Jun;86(6):1027-1032. doi: 10.1097/TA.0000000000002232.
Information on long-term psychiatric sequelae after severe trauma is sparse. We therefore performed a survey addressing several symptoms related to posttraumatic stress disorder (PTSD) in patients who sustained multiple injuries more than 20 years after trauma.
Patients injured between January 1, 1973, and December 31, 1990, were contacted at least 20 years later. We included multiply injured patients aged between 3 and 60 years from a single level 1 trauma center. A questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for PTSD, including individual symptoms related to intrusion, avoidance, and hyperarousal was sent to all patients.
A total of 359 patients (56.35%) received a questionnaire. Of these, 337 patients (93.87%) returned the questionnaire and were included in the study (223 males [66.17%] and 114 females [33.82%]). Mean ± SD follow-up was 29.5 ± 8.5 years. Nearly half the study population (47.18%) experienced lasting psychiatric sequelae, such as intrusive recollection (n = 65, 19.28%), avoidance (n = 92, 27.29%), or hyperarousal (n = 95, 28.18%) at least monthly. Ten patients (2.96%) fulfilled all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for PTSD. A total of 131 patients (38.87%) reported fair or poor general health status. There was no difference in injury severity in patients with or without PTSD (injury severity score, 8.33 vs. 20.36, respectively; p = 0.52) or PTSD-related symptoms including intrusion (19.88 vs. 20.32, p = 0.74), avoidance (19.99 vs. 20.3, p = 0.79), and hyperarousal (19.36 vs. 20.68, p = 0.26).
At least 20 years after injury, no correlation was found between the development of psychiatric complications and the severity of injury. While the rate of full-blown PTSD was low, nearly half the study population regularly suffered from at least one psychiatric symptom attributable to the initial trauma. Awareness for the development of psychiatric complications and early initiation of psychiatric counseling are advisable.
Prognostic and epidemiologic, level II.
关于严重创伤后长期精神后遗症的信息很少。因此，我们进行了一项调查，调查了 20 多年前遭受多处创伤的患者与创伤后应激障碍（PTSD）相关的几种症状。
至少在 20 年后联系了 1973 年 1 月 1 日至 1990 年 12 月 31 日受伤的患者。我们纳入了来自一家单一的 1 级创伤中心的年龄在 3 至 60 岁之间的多发性受伤患者。将一份基于精神障碍诊断和统计手册，第四版，包括与入侵、回避和过度警觉相关的个体症状的 PTSD 诊断标准的问卷发送给所有患者。
共有 359 名患者（56.35%）收到了问卷。其中，337 名患者（93.87%）返回了问卷并被纳入研究（223 名男性[66.17%]和 114 名女性[33.82%]）。平均随访时间为 29.5 ± 8.5 年。近一半的研究人群（47.18%）经历了持久的精神后遗症，例如侵入性回忆（n = 65，19.28%）、回避（n = 92，27.29%）或过度警觉（n = 95，28.18%）每月至少一次。10 名患者（2.96%）符合精神障碍诊断和统计手册，第四版，PTSD 的所有诊断标准。共有 131 名患者（38.87%）报告一般健康状况不佳或较差。有 PTSD 或无 PTSD 的患者的伤害严重程度没有差异（伤害严重程度评分，分别为 8.33 和 20.36；p = 0.52）或与 PTSD 相关的症状，包括入侵（19.88%和 20.32%，p = 0.74）、回避（19.99%和 20.3%，p = 0.79）和过度警觉（19.36%和 20.68%，p = 0.26）。
受伤至少 20 年后，精神并发症的发展与伤害的严重程度之间没有相关性。虽然完全性 PTSD 的发生率很低，但近一半的研究人群经常至少出现一种与初始创伤有关的精神症状。建议对精神并发症的发展保持警惕，并尽早开始进行精神咨询。
预后和流行病学，II 级。
