Routine versus ad hoc screening for acute stress following injury: who would benefit and what are the opportunities for prevention

Bell, Nathaniel; Sobolev, Boris; Anderson, Stephen C.; Hewko, Robert; Simons, Richard K.

doi:10.1186/1752-2897-8-5

Cited by 7 publications

(9 citation statements)

References 27 publications

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“…Regardless, there were clinically significant results finding that use of the PC-PTSD assisted in identifying patients who need health psychology, and many of them were recommended to receive outpatient health psychology. The percentage of patients deemed at risk was also similar to other studies that address the prevalence of traumatic stress in the trauma population (Bell et al, 2014;Bertelson et al, 2011;Reese et al, 2012;Zatzick et al, 2007). These findings can positively affect the patient in the primary care setting as well.…”

Section: Resultssupporting

confidence: 85%

“…This outcome can be seen as clinically significant in that those who were screened and seen by health psychology were deemed as higher risk for traumatic stress disorders by needing this additional follow-up care. The percentage of patients who were consulted with health psychology for being at risk for traumatic stress disorder was also similar to other studies that performed screening for maladaptive traumatic stress (Bell, Sobolev, Anderson, Hewko, & Simons, 2014;Bertelson et al, 2011;Reese et al, 2012;Zatzick et al, 2007). In this study, 28% of the patients received a health psychology consult with the use of the PC-PTSD tool.…”

Section: Discussionsupporting

confidence: 84%

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Addressing Traumatic Stress in the Acute Traumatically Injured Patient

Frank¹,

Schroeter²,

Shaw³

2017

Journal of Trauma Nursing

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Psychological injuries after an acute traumatic event are commonly overlooked. Currently within United States, there is no consistently utilized screening process that addresses traumatic stress within the acute trauma population. Roy's Adaptation Model guided this project, focusing on the idea that bedside nurses are at the frontline of providing early identification through nursing assessment. The purpose of this pilot study was to evaluate whether the implementation of the Primary Care-Posttraumatic Stress Disorder (PC-PTSD) screening tool by bedside nurses would result in identifying more patients at risk for traumatic stress after an acute trauma as compared with the use of no screening method. This descriptive survey study took place over a 6-week period at a Midwest Level 1 trauma hospital. The results revealed that the tool did not increase the number of health psychology consults when compared with the same 6-week period a year prior when no tool was used. Nonetheless, use of the PC-PTSD tool did trigger 28% of the patients to receive a health psychology consult. Forty-five percent of patients who received a health psychology consult were recommended outpatient therapy. Utilization of this tool by bedside nurses did not adversely increase a number of inappropriate health psychology consults. These results agree with the literature and further suggest that there are a clinically significant number of acute trauma patients who are at risk for traumatic stress. With this screening tool, nurses accurately assessed patients and connected them with timely psychological treatment.

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Section: Resultssupporting

confidence: 85%

Section: Discussionsupporting

confidence: 84%

Addressing Traumatic Stress in the Acute Traumatically Injured Patient

Frank¹,

Schroeter²,

Shaw³

2017

Journal of Trauma Nursing

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“…Research is needed that will consider a variety of causes of trauma exposure as well as single and multiple severe injuries (Lowe et al, 2020 ). The follow-up period and measurements in recent studies have often been limited (Bonanno et al, 2012 ; deRoon-Cassini, Mancini, Rusch, & Bonanno, 2010 ), or investigations have used a cross-sectional design (Bell, Sobolev, Anderson, Hewko, & Simons, 2014 ; Campbell, Trachik, Goldberg, & Simpson, 2020 ). Hence, multiple measurements during a longer follow-up period are needed.…”

Section: Introductionmentioning

confidence: 99%

Psychological risk factors that characterize acute stress disorder and trajectories of posttraumatic stress disorder after injury: a study using latent class analysis

Visser

Oudsten

Lodder

et al. 2022

European Journal of Psychotraumatology

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Background The course and different characteristics of acute and posttraumatic stress disorder (ASD, PTSD) in trauma populations are unclear. Objective The aims were to identify longitudinal trajectories of PTSD, to establish a risk profile for ASD and PTSD based on patients’ sociodemographic, clinical, and psychological characteristics, and to study the effect of ASD and dissociation on PTSD during 12 months after trauma. Method Patients completed questionnaires after inclusion and at 3, 6, 9, and 12 months afterwards. Trajectories were identified using repeated measures latent class analysis (RMLCA). The risk profile was based on a ranking of importance of each characteristic using Cohen’s d effect sizes and odds ratios. The impact of ASD and dissociation on PTSD was examined using logistic regression analyses. Results Altogether, 267 patients were included. The mean age was 54.0 ( SD = 16.1) and 62% were men. The prevalence rate of ASD was approximately 21.7% at baseline, and 36.1% of trauma patients exhibited PTSD at 12 months after injury. Five trajectories were identified: (1) no PTSD symptoms, (2) mild, (3) moderate, (4) subclinical, and (5) severe PTSD symptoms. These trajectories seemed to remain stable over time. Compared with patients in other trajectories, patients with ASD and (subclinical) PTSD were younger and scored higher on anxiety, depressive symptoms, neuroticism, and trait anxiety. Regarding dissociation symptoms, inability to recall memories about the event was significantly more present than an altered sense of reality, (105 (40.7%) versus 56 (21.7%), p = .031), although that symptom had the strongest likelihood for PTSD. Patients with dissociation were significantly at risk for PTSD than patients without dissociation (OR = 4.82; 95%CI: 1.91–12.25). Conclusions Psychological factors characterized ASD and trajectories of PTSD during 12 months post-trauma. Healthcare providers who are aware of these findings could early identify patients at risk for ASD and PTSD and refer them for patient-centred interventions.

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“…There is variable awareness of the PTSD screening guidelines and minimal guidance on how to implement a screening protocol in this setting. Implementation of PTSD screening is needed, and positive opinions and good outcomes of PTSD screening have been demonstrated 17 18. The results of the current study suggest a culture that will support implementation of PTSD screening with assistance.…”

Section: Discussionmentioning

confidence: 73%

Barriers to and facilitators of a screening procedure for PTSD risk in a level I trauma center

McBain

Sexton

Palmer

et al. 2019

Trauma Surg Acute Care Open

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BackgroundPatients admitted to the hospital after an injury are at a greater risk for developing post-traumatic stress disorder (PTSD) due to the nature of the injury and the traumatic nature of necessary medical interventions. Many level I trauma centers have yet to implement screening protocols for PTSD risk. The goal of the study was to characterize the barriers to and facilitators of implementation of a screening procedure for PTSD risk in a level I trauma center.MethodsWe conducted semistructured qualitative interviews with multidisciplinary academic medical center stakeholders (N=8) including those with clinical, research, teaching, and administrative roles within an urban academic medical center’s Department of Surgery, Division of Acute Care Surgery. We analyzed the qualitative data using summative template analysis to abstract data related to participants’ opinions about implementation of a screener for PTSD.ResultsParticipants’ general perception of screening for PTSD risk after injury was positive. Identified challenges to implementation included timing of screening, time burden, care coordination, addressing patients with traumatic brain injury or an altered mental status, and ensuring appropriate care after screening. Reported facilitators included existing psychosocial screening tools and protocols that would support inclusion of a PTSD screener, a patient-centered culture that would facilitate buy-in from providers, a guideline-driven culture, and a commitment to continuity of care.ConclusionsThis study offers concrete preliminary information on barriers to and facilitators of PTSD screening that can be used to inform planning of implementation efforts within a trauma center.Level of evidenceLevel V, qualitative.

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Routine versus ad hoc screening for acute stress following injury: who would benefit and what are the opportunities for prevention

Cited by 7 publications

References 27 publications

Addressing Traumatic Stress in the Acute Traumatically Injured Patient

Addressing Traumatic Stress in the Acute Traumatically Injured Patient

Psychological risk factors that characterize acute stress disorder and trajectories of posttraumatic stress disorder after injury: a study using latent class analysis

Barriers to and facilitators of a screening procedure for PTSD risk in a level I trauma center

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