Nguyen Jefferson, Whiteside Lauren K, Bulger Eileen M, Veach Laura, Moloney Kathleen, Russo Joan, Nehra Deepika, Wang Jin, Zatzick Douglas F
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Trauma Surg Acute Care Open. 2022 Aug 4;7(1):e000913. doi: 10.1136/tsaco-2022-000913. eCollection 2022.
Questions regarding the extent to which post-traumatic stress disorder (PTSD) is comorbid with alcohol and drug use are particularly germane in an era when the American College of Surgeons Committee on Trauma (ACS-COT) is considering policy requiring screening, intervention and/or referral services for patients presenting with psychological sequalae of traumatic injury. Literature review revealed few multisite trauma-center-based investigations that have assessed the association between PTSD symptoms and alcohol and drug use comorbidities in injured patients.
This investigation was a secondary analysis of baseline data collected prior to randomization in a 25-site trauma center pragmatic clinical trial. All 635 patients included in the investigation had elevated PTSD symptom levels at the time of trauma center admission. Self-report questionnaire screening, laboratory toxicology results, and electronic health record data were combined to assess the frequencies of alcohol, stimulant (i.e., amphetamine and cocaine), opioid and marijuana use comorbidities for injured patients. Logistic regression was used to assess the associations between demographic and injury characteristics and alcohol and drug use comorbidity.
The frequency of patients with one or more alcohol or substance use comorbidity was between 62% and 79%. Over 50% of patients were positive for one or more alcohol or cannabis comorbidity. Approximately 26% of patients were positive for stimulants and 10% for opioid comorbidity.
This multisite investigation suggests that between 62% and 79% of hospitalized injury survivors with elevated PTSD symptoms have one or more alcohol or drug use comorbidity. Orchestrated ACS-COT policy and trauma center service delivery development should incorporate the key finding that a substantial majority of patients with high levels of psychological distress (eg, elevated PTSD symptoms) may have alcohol and drug use comorbidities.
Level II (epidemiological investigation of untreated controls from a multisite randomized clinical trial).
NCT02655354.
在美国外科医师学会创伤委员会（ACS - COT）正在考虑制定政策，要求对有创伤性损伤心理后遗症的患者进行筛查、干预和/或转诊服务的时代，关于创伤后应激障碍（PTSD）与酒精和药物使用共病程度的问题尤为相关。文献综述显示，很少有基于多创伤中心的调查评估创伤患者中PTSD症状与酒精和药物使用共病之间的关联。
本调查是对一项在25个创伤中心进行的实用临床试验随机分组前收集的基线数据的二次分析。纳入调查的所有635名患者在创伤中心入院时PTSD症状水平均升高。结合自我报告问卷筛查、实验室毒理学结果和电子健康记录数据，评估创伤患者酒精、兴奋剂（即苯丙胺和可卡因）、阿片类药物和大麻使用共病的频率。采用逻辑回归评估人口统计学和损伤特征与酒精和药物使用共病之间的关联。
有一种或多种酒精或物质使用共病的患者频率在62%至79%之间。超过50%的患者一种或多种酒精或大麻共病呈阳性。约26%的患者兴奋剂呈阳性，10%的患者阿片类药物共病呈阳性。
这项多中心调查表明，62%至79%有PTSD症状升高的住院创伤幸存者有一种或多种酒精或药物使用共病。精心策划的ACS - COT政策和创伤中心服务提供发展应纳入这一关键发现，即绝大多数心理困扰程度高（如PTSD症状升高）的患者可能有酒精和药物使用共病。
二级（来自多中心随机临床试验未治疗对照的流行病学调查）。
NCT02655354。
