Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees

Abstract

Abstract-Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV) morphine (vs IV fentanyl) after injury was associated with reduced likelihood of posttraumatic stress disorder (PTSD). The previous results were based on military health diagnoses over 2 yr postinjury. The present study followed psychological diagnoses of patients with amputation for 4 yr using military and Department of Veterans Affairs health data. Intheater combat casualty records (n = 145) documented Glasgow Coma Scale (GCS) scores and/or morphine, fentanyl, or no opioid treatment within hours of injury. We found that (1) GCS scores were not significantly associated with PTSD; (2) longitudinal modeling using four (yearly) time points showed significantly reduced odds of PTSD for patients treated with morphine (vs fentanyl) across years (adjusted odds ratio = 0.40; 95% confidence interval = 0.17-0.94); (3) reduced PTSD prevalence for morphine (vs IV fentanyl; morphine = 25%, fentanyl = 59%, p < 0.05) was significant, specifically among patients with traumatic brain injury during the first 2 yr postinjury; and (4) PTSD prevalence, but not other disorders (e.g., mood), increased between year 1 (PTSD = 18%) and years 2 through 4 postinjury (PTSD range = 30%-32%).

A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage

“…This increase in PTSD may reflect the stress of discharge from military service and the transition to VA healthcare and/or quality-of-life issues [37–38]. We recently reported this finding for a smaller sample of 258 US servicemembers with combat related amputations [39]. The present results show that this finding extends to the larger population of patients with combat related amputations or limb salvage.…”

Complexity of the Relationships of Pain, Posttraumatic Stress, and Depression in Combat‐Injured Populations: An Integrative Review to Inform Evidence‐Based Practice

“…Melcer et al. () confirm the success of early pain management with morphine, over other medications, in reducing odds of developing PTSD up to 4 years after injury (OR, 0.40; 95% CI [0.17, 0.94]). Further, McGhee, Maani, Garza, Gaylord, and Black () and McGhee et al.…”

“…Several studies demonstrate the need to screen and identify predeployment risk factors, such as mental disorders and previous traumatic exposures. Researchers identified associations between injury severity (Baker et al., ; MacGregor, Corson et al., ; MacGregor, Shaffer et al., ; MacGregor et al., ; Sandweiss et al., ) and pain management in developing PTSD postinjury (Holbrook et al., ; McGhee et al., ; McGhee et al., ; Melcer et al., ). Mechanistic type of injury, particularly blast or in combination with blunt and penetrating trauma, can influence the development of postinjury mental health symptoms (e.g., PTSD and depression; Clark et al., ; McLay et al., ; Mora et al., ; Pugh et al., ).…”

<p>Retrospective study of cardiovascular disease risk factors among a cohort of combat veterans with lower limb amputation</p>

“…To partially control for factors related to the physical and emotional stress of combat injury, the control group included veterans with serious combat-related lower limb injury without amputation. All patients were identified in the Naval Health Research Center (NHRC) Expeditionary Medical Encounter Database (EMED)11 and, similar to our prior work, we linked members of the cohort identified in military databases to health data from the Department of Veterans Affairs (VA) national repositories 6,12–14. Compared to veterans with combat-related lower limb injury, we expected a higher prevalence of CVD risk factors, including higher blood pressure and dyslipidemia, among veterans with unilateral or bilateral lower limb amputation.…”