Current Practices and Beliefs Regarding Screening Patients with Burns for Acute Stress Disorder and Posttraumatic Stress Disorder: A Survey of the American Burn Association Membership

Abstract

Stress disorders are common after burn injuries and universal screening is recommended. This study describes current screening practices and provider beliefs regarding screening for stress disorders in patients with burns in the US. This was a 31-question survey distributed to the American Burn Association. Sixty-two percent of 121 respondents indicated their institution formally screened for ASD and/or PTSD. The most common reason for not screening was a lack of mental healthcare providers (46%), lack of funding (26%) and lack of time (20%). The timing of screening, the person administering the screening, and the method of screening varied for both pediatric and adult patients. Most respondents (87%) believed screening should be a standard of care, but only 32% were comfortable screening pediatric patients and 62% were comfortable screening adults. While screening for ASD and PTSD is recommended for patients with burns, our study indicates that screening is not a current standard of care. Lack of mental healthcare providers, funding, and time are contributing factors. Among those institutions that screen, a uniform screening practice does not exist.

Development and Testing of the Aftercare Problem List, a Burn Aftercare Screening Instrument

“…This study has some implications for clinical practice. First, the Aftercare Problem List, comprising both physical and psychosocial items, can be used for screening purposes, which is in line with recommendations emphasizing the need for screening problems after burns [22]. As it uncovers psychosocial problems and inquires about preference to discuss these concerns, it helps to increase psychological presence and may reduce stigma related to mental health problems; both were recently identified as barriers for burn survivors to seek psychological help [37].…”

“…In recent years, interest has grown in (early) screening following burns [21][22][23]. Particularly professionals working in the psychosocial field endorse screening in order to inform tailored interventions in a timely manner [18].…”

A Narrative Review of the History of Burn-Related Depression and Stress Reactions

“…Recognizing the importance of ASD and PTSD, the American Burn Association (ABA) recommended in 2012 that all burn patients receive screening for depression, ASD and PTSD [ 17 ]. In 2019, the ABA began requiring psychological screening for PTSD, depression, suicidal ideation and substance abuse and relevant intervention for burn centers as an aspect of accreditation [ 18 ]. Burn survivors with psychiatric disorders are likely to experience longer hospital length of stay, more surgical procedures, higher levels of dysfunction, an increased need for medical assistance, and an increased risk of suicide [ 19 , 20 , 21 ].…”