Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Department of Surgery, Plastic Surgery, Hamad Medical Corporation, Doha, Qatar.
PLoS One. 2020 Nov 30;15(11):e0242849. doi: 10.1371/journal.pone.0242849. eCollection 2020.
Psychological distress following traumatic injury can influence the patient health, well-being and quality of life; however, this impact may partly vary according to the type and severity of injury. We aimed to study the predominant distress causing cluster and individual symptoms of Post-Traumatic Stress Disorders (PTSD) at the clinical and subthreshold level in patients with traumatic injuries, based on the mechanism of injury (MOI).
A hospital based cross-sectional study was conducted at a Level 1 Trauma Center utilizing PTSD Checklist to diagnose PTSD after one month of the traumatic event. All patients suffering from psychological distresses were assessed by a clinical psychologist in the trauma section. PTSD diagnostic criteria from DSM-5 were used to classify the patients. The inclusion criteria comprised of adult trauma patients who were directly involved in traumatic injuries and admitted under the Trauma Surgery services for a minimum of one day; have ability to provide written informed consent and can be assessed with the PCL-5 checklist after 4 weeks post-injury.
Two hundred patients completed PCL-5 checklist, of them 26 (13.0%) were positive for PTSD and 174 (87%) had subthreshold scores. The mean age of participants was 34.4±11.8 years and males constituted 90.5%. Road traffic injury (RTI) was most the frequent injury mechanism (59%). PTSD positive patients with RTI, fall of heavy objects, pedestrian injury and assaults had highest average scores on clusters of negative alterations in mood and cognitions (16.9, 18.0, 18.5, 17.0 respectively), followed by hyperarousal. Symptom of always being on the guard and having repeated unwanted or disturbing memories of the incident, was reported by nearly 100% PTSD positive patients. Patients with subthreshold scores also reported distressing symptoms on all four clusters of PTSD.
Patients with different MOI showed a broad range of psychological problems with respect to symptom clusters. Negative alteration in mood and cognition followed by hyperarousal caused higher level of distress in patients post traumatic injuries. Subthreshold symptoms of PTSD are more common and deserve more attention.
创伤后心理困扰会影响患者的健康、幸福感和生活质量；然而，这种影响可能部分取决于损伤的类型和严重程度。我们旨在根据损伤机制 (MOI) 研究创伤后患者在临床和亚阈值水平上 PTSD 引起的主要困扰集群和个体症状。
在 1 级创伤中心进行基于医院的横断面研究，在创伤事件发生一个月后使用 PTSD 检查表来诊断 PTSD。所有有心理困扰的患者都由创伤科的临床心理学家进行评估。使用 DSM-5 的 PTSD 诊断标准对患者进行分类。纳入标准包括直接参与创伤性损伤并在创伤外科服务部门至少住院一天的成年创伤患者；有书面知情同意的能力，并能在受伤后 4 周内用 PCL-5 检查表进行评估。
200 名患者完成了 PCL-5 检查表，其中 26 名（13.0%）对 PTSD 呈阳性，174 名（87%）为亚阈值分数。参与者的平均年龄为 34.4±11.8 岁，男性占 90.5%。道路交通伤害（RTI）是最常见的损伤机制（59%）。RTI、重物坠落、行人受伤和袭击导致 PTSD 阳性患者的心境和认知的负性改变（16.9、18.0、18.5、17.0）、警觉性增高集群的平均得分最高，其次是警觉性增高。近 100%的 PTSD 阳性患者报告说他们总是处于戒备状态，并且反复出现对事件的不必要或令人不安的记忆。亚阈值分数的患者也报告了 PTSD 所有四个集群的困扰症状。
具有不同 MOI 的患者表现出广泛的心理问题，表现为症状集群。创伤后心境和认知的负性改变，其次是警觉性增高，会给患者带来更高水平的困扰。亚阈值症状的 PTSD 更为常见，需要更多关注。
