Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
Departments of Nursing and Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA.
Injury. 2024 May;55(5):111426. doi: 10.1016/j.injury.2024.111426. Epub 2024 Feb 29.
Early intervention for patients at risk for Posttraumatic Stress Disorder (PTSD) relies upon the ability to engage and follow trauma-exposed patients. Recent requirements by the American College of Surgeons Committee on Trauma (College) have mandated screening and referral for patients with high levels of risk for the development of PTSD or depression. Investigations that assess factors associated with engaging and following physically injured patients may be essential in assessing outcomes related to screening, intervention, and referral.
This investigation was a secondary analysis of data collected as part of a United States level I trauma center site randomized clinical trial. All 635 patients were ages ≥18 and had high PTSD symptom levels (i.e., DSM-IV PTSD Checklist score ≥35) at the time of the baseline trauma center admission. Baseline technology use, demographic, and injury characteristics were collected for patients who were followed up with over the course of the year after physical injury. Regression analyses were used to assess the associations between technology use, demographic and injury characteristics, and the attainment of follow-up outcome assessments.
Thirty-one percent of participants were missing one or more 3-, 6- or 12-month follow-up outcome assessments. Increased risk of missing one or more outcome assessments was associated with younger age (18-30 versus ≥55 Relative Risks [RR] = 1.78, 95 % Confidence Interval [CI] = 1.09, 2.91), lack of cell phone (RR = 1.32, 95 % CI = 1.01, 1.72), no internet access (RR = 1.47, 95 % CI = 1.01, 2.16), public versus private insurance (RR = 1.47, 95 % CI = 1.12, 1.92), having no chronic medical comorbidities (≥4 versus none, RR = 0.28, 95 % CI = 0.20, 0.39), and worse pre-injury mental health function (RR = 0.99, 95 % CI = 0.98, 0.99).
This multisite investigation suggests that younger and publicly insured and/or uninsured patients with barriers to cell phone and internet access may be particularly vulnerable to lapses in trauma center follow-up. Clinical research informing trauma center-based screening, intervention, and referral procedures could productively explore strategies for patients at risk for not engaging and adhering to follow-up care and outcome assessments.
对于创伤后应激障碍（PTSD）高危患者的早期干预依赖于接触和随访创伤暴露患者的能力。美国外科医师学院创伤委员会（College）最近的要求规定，对 PTSD 或抑郁发生风险高的患者进行筛查和转介。评估与接触和随访身体受伤患者相关的因素的研究可能对于评估筛查、干预和转介相关的结果至关重要。
本研究是美国一级创伤中心现场随机临床试验数据的二次分析。所有 635 名患者年龄均≥18 岁，基线创伤中心入院时 PTSD 症状水平较高（即 DSM-IV PTSD 清单得分≥35）。收集了在身体受伤后一年内进行随访的患者的基线技术使用、人口统计学和损伤特征。回归分析用于评估技术使用、人口统计学和损伤特征与获得随访结果评估之间的关联。
31%的参与者缺失一个或多个 3、6 或 12 个月的随访结果评估。错过一个或多个结果评估的风险增加与年龄较小（18-30 岁与≥55 岁，相对风险 [RR] = 1.78，95%置信区间 [CI] = 1.09，2.91）、无手机（RR = 1.32，95%CI = 1.01，1.72）、无互联网接入（RR = 1.47，95%CI = 1.01，2.16）、公共保险与私人保险（RR = 1.47，95%CI = 1.12，1.92）、无慢性合并症（≥4 种与无，RR = 0.28，95%CI = 0.20，0.39）、受伤前心理健康功能较差（RR = 0.99，95%CI = 0.98，0.99）相关。
这项多地点研究表明，年轻、公共保险和/或无保险且手机和互联网接入存在障碍的患者可能特别容易错过创伤中心的随访。为基于创伤中心的筛查、干预和转介程序提供信息的临床研究可以探索针对风险患者的策略，这些患者可能无法接触和坚持随访护理和结果评估。
