Impact of the “Polytrauma Clinical Triad” on Sleep Disturbance in a Department of Veterans Affairs Outpatient Rehabilitation Setting

Lew, Henry L.; Pogoda, Terri K.; Hsu, Pei-Te; Cohen, Suzanne L.; Amick, Melissa M.; Baker, Errol; Meterko, Mark; Vanderploeg, Rodney D.

doi:10.1097/phm.0b013e3181ddd301

Cited by 91 publications

(76 citation statements)

References 31 publications

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“…Even during the first 2 yr after injury, we found substantially higher rates of PTSD and "other" psychological diagnoses such as postconcussive syndrome, using both military and VA data sources versus military sources alone [6,8,27]. This finding may also reflect compartmentalization of care, whereby some TBI and/or PTSD cases are referred directly to VA centers for postinjury treatment and, thus, not captured/coded within the military system [32]. Researchers following combat-related PTSD and TBI outcomes should consider incorporating both military and VA health data.…”

Section: Datamentioning

confidence: 63%

“…However, this association in the present study was not statistically significant when additional PTSD diagnoses were included from VA health data. Notably, military physicians often refer serious head/spinal injury patients to VA Centers of Excellence rather than less specialized military facilities [32]. This may explain the additional PTSD diagnoses recorded by VA sources, particularly for patients with relatively high GCS scores.…”

Section: Discussionmentioning

confidence: 99%

“…The primary limitation was small sample size. The diagnostic criteria for PTSD overlaps with other psychological disorders (e.g., TBI, mood, and postconcussion syndrome) and, therefore, cases of PTSD might have been misdiagnosed [32]. To minimize this problem, we included PTSD cases only for patients with at least two separate PTSD diagnoses [39].…”

Section: Datamentioning

confidence: 99%

“…As in the previous study, we expected this association between IV morphine and PTSD and mood disorder only among patients with TBI. We also expected a general increase in PTSD rates over the long term, based on VA health data showing relatively high rates of PTSD among militaryseparated combat veterans [31][32].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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%).

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Section: Datamentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Datamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2014

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“…Because of the degree of symptom overlap between TBI and psychiatric disorders [46,61,[63][64]66,[76][77][78][79][80], clinicians evaluating TBI also should determine whether mental health conditions are present to decide on the best course of treatment [6,62]. Patients with MSI may benefit from a team-based approach to care [63][64][77][78].…”

Section: Discussionmentioning

confidence: 99%

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Pogoda¹,

Hendricks²,

Iverson³

et al. 2012

JRRD

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Abstract-With the use of Veterans Health Administration and Department of Defense databases of veterans who completed a Department of Veterans Affairs comprehensive traumatic brain injury (TBI) evaluation, the objectives of this study were to (1) identify the co-occurrence of self-reported auditory, visual, and vestibular impairment, referred to as multisensory impairment (MSI), and (2) examine demographic, deployment-related, and mental health characteristics that were potentially predictive of MSI. Our sample included 13,746 veterans with either a history of deployment-related mild TBI (mTBI) (n = 9,998) or no history of TBI (n = 3,748). The percentage of MSI across the sample was 13.9%, but was 17.4% in a subsample with mTBI history that experienced both nonblast and blast injuries. The factors that were significantly predictive of reporting MSI were older age, being female, lower rank, and etiology of injury. Deployment-related mTBI history, posttraumatic stress disorder, and depression were also significantly predictive of reporting MSI, with mTBI history the most robust after adjusting for these conditions. A better comprehension of impairments incurred by deployed servicemembers is needed to fully understand the spectrum of blast and nonblast dysfunction and may allow for more targeted interventions to be developed to address these issues.

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Sleep Quality and Reexperiencing Symptoms of PTSD Are Associated With Current Pain in U.S. OEF/OIF/OND Veterans With and Without mTBIs

Powell

Corbo

Fonda

et al. 2015

Journal of Traumatic Stress

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Pain, a debilitating condition, is frequently reported by U.S. veterans returning from Afghanistan and Iraq. This study investigated how commonly reported clinical factors were associated with pain and whether these associations differed for individuals with a history of chronic pain. From the Boston metropolitan area, 171 veterans enrolled in the Veterans Affairs Center of Excellence were assessed for current posttraumatic stress disorder (PTSD) symptom severity, current mood and anxiety diagnoses, lifetime traumatic brain injury, combat experiences, sleep quality, and alcohol use. Hierarchical regression models were used to determine the association of these conditions with current pain. Average pain for the previous 30 days, assessed with the McGill Pain Questionnaire, was 30.07 out of 100 (SD = 25.43). Sleep quality, PTSD symptom severity, and alcohol use were significantly associated with pain (R(2) = .24), as were reexperiencing symptoms of PTSD (R(2) = .25). For participants with a history of chronic pain (n = 65), only PTSD symptoms were associated with pain (R(2) = .19). Current pain severity was associated with increased PTSD severity (notably, reexperiencing symptoms), poor sleep quality, and increased alcohol use. These data support the hypothesis that PTSD symptoms influence pain, but suggest that problems with sleep and alcohol use may exacerbate the relationship.

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Impact of the “Polytrauma Clinical Triad” on Sleep Disturbance in a Department of Veterans Affairs Outpatient Rehabilitation Setting

Cited by 91 publications

References 31 publications

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

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

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Sleep Quality and Reexperiencing Symptoms of PTSD Are Associated With Current Pain in U.S. OEF/OIF/OND Veterans With and Without mTBIs

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