Gunshot Trauma Patients Have Higher Risk of PTSD Compared With Blunt Trauma and Elective Populations: A Retrospective Comparative Study of Outpatient Orthopaedic Care.

IF 4.2 2区 医学 Q1 ORTHOPEDICS
Jennifer Moriatis Wolf, Fatima Bouftas, David C Landy, Jason A Strelzow
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引用次数: 0

Abstract

Background: Posttraumatic stress disorder (PTSD) has been extensively studied in patients who have experienced natural disasters or military conflict, but there remains a substantial gap in knowledge about the prevalence of PTSD after civilian orthopaedic trauma, especially as related to firearms. Gun violence is endemic in the United States, especially in urban centers, and the mental impact is often minimized during the treatment of physical injuries.

Questions/purposes: (1) Do patients who experience gunshot wound (GSW) trauma have higher PTSD screening scores compared with patients with blunt or other trauma (for example, motor vehicle and motorcycle accidents or stab wounds) and those with elective conditions (for example, arthritis, tendinitis, or nerve compression)? (2) Are PTSD scores correlated with pain scores in patients with GSW trauma, those with non-GSW trauma, and patients with elective orthopaedic symptoms?

Methods: We performed a retrospective study of adults older than 18 years of age presenting to an orthopaedic clinic over an 8-month period between August 2021 and May 2022. All patients presenting to the clinic were approached for inclusion (2034 patients), and 630 new or postoperative patients answered study surveys as part of routine care. Patients were divided into three cohorts based on the orthopaedic condition with which they presented, whether gunshot trauma, blunt trauma, or elective orthopaedic symptoms. Overall, the results from 415 patients were analyzed, including 212 patients with elective orthopaedic symptoms, 157 patients with non-GSW trauma, and 46 patients with GSW trauma. Clinical data including demographic information were collected at the time of appointment and abstracted along with results from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, short screening questionnaire, which uses a 7-item scale scored from 0 to 7 (with higher scores representing worse symptoms), and from the numeric rating scale for pain (range 0 to 10). Both questionnaires were routinely administered by medical assistants at patient intake. The proportions of patients completing PTSD scoring were 45% (95) in the elective group, 74% (116) in the group with non-GSW trauma, and 85% (39) in the group with GSW trauma (p = 0.01). We compared the PTSD scores across the three groups and then dichotomized the scores as a negative versus positive screening result at a value of ≥ 4 with further comparative analysis. The correlation between pain and PTSD scores was also evaluated.

Results: Patients with GSW trauma had higher mean ± SD PTSD scores compared with those who had non-GSW trauma (4.87 ± 4.05 versus 1.75 ± 2.72, mean difference 3.21 [95% CI 1.99 to 4.26]; p < 0.001) and those who presented with elective conditions (4.87 ± 4.05 versus 0.49 ± 1.04, mean difference 4.38 [95% CI 3.50 to 5.26]; p < 0.001). When dichotomized for positive or negative PTSD screening results, patients with GSW trauma had a higher risk of having PTSD (64% [25 of 39]) compared with patients with non-GSW trauma (27% [31 of 116], relative risk 2.40 [95% CI 1.64 to 3.51]; p < 0.001) and compared with patients with elective conditions (4% [4 of 95], relative risk 15.22 [95% CI 5.67 to 40.87]; p < 0.001). Pain scores were correlated with PTSD scores only for patients with non-GSW trauma (ρ = 0.37; p < 0.0001). No correlation with pain scores was present for patients with GSW (ρ = 0.24; p = 0.16) or patients with elective conditions (ρ = -0.04; p = 0.75).

Conclusion: In an orthopaedic clinic population, the prevalence of positive screening for PTSD was highest in the population sustaining gunshot trauma as compared with blunt or other trauma and elective orthopaedic conditions. Interestingly, pain scores correlated with PTSD screening only in the patients with non-GSW trauma. These differences suggest a substantial difference in the populations at risk of PTSD after trauma. Overall, the psychological impacts of gun trauma are poorly understood. The next step would be to prospectively study the differences and timelines of PTSD screening in patients with GSW trauma in comparison with patients with blunt or other trauma to better define the treatment needs in this population.

Level of evidence: Level III, prognostic study.

与钝器伤和择期手术人群相比,枪伤患者患创伤后应激障碍的风险更高:骨科门诊护理的回顾性比较研究》。
背景:创伤后应激障碍(PTSD)在经历过自然灾害或军事冲突的患者身上得到了广泛的研究,但对于平民骨科创伤后创伤后应激障碍的发病率,尤其是与枪支有关的创伤后应激障碍的发病率,仍然存在很大的知识差距。问题/目的:(1) 与钝伤或其他创伤(如机动车和摩托车事故或刀伤)患者以及患有选择性疾病(如关节炎、肌腱炎或神经压迫)的患者相比,经历枪伤(GSW)创伤的患者是否具有更高的创伤后应激障碍筛查评分?(2) 创伤后应激障碍评分是否与GSW创伤患者、非GSW创伤患者和选择性骨科症状患者的疼痛评分相关?我们对 2021 年 8 月至 2022 年 5 月的 8 个月期间到骨科诊所就诊的 18 岁以上成年人进行了一项回顾性研究。所有到该诊所就诊的患者(2034 名患者)都被纳入研究范围,630 名新患者或术后患者回答了研究调查问卷,这是常规护理的一部分。根据患者的骨科病症(枪伤、钝伤或选择性骨科症状)将其分为三组。总共对 415 名患者的结果进行了分析,其中包括 212 名有选择性骨科症状的患者、157 名非 GSW 创伤患者和 46 名 GSW 创伤患者。在预约时收集了包括人口统计学信息在内的临床数据,并摘录了《精神疾病诊断与统计手册》第四版简短筛查问卷和疼痛数字评分量表(范围在 0 到 10 之间)的结果。这两份问卷均由医疗助理在患者入院时例行发放。完成创伤后应激障碍评分的患者比例分别为:择期手术组 45%(95 人),非 GSW 创伤组 74%(116 人),GSW 创伤组 85%(39 人)(P = 0.01)。我们比较了三组患者的创伤后应激障碍评分,然后在评分值≥4 时将其二分为阴性和阳性筛查结果,并进行进一步比较分析。此外,还评估了疼痛与创伤后应激障碍得分之间的相关性:结果:与非 GSW 外伤患者(4.87 ± 4.05 对 1.75 ± 2.72,平均差 3.21 [95% CI 1.99 至 4.26];p < 0.001)和择期就诊患者(4.87 ± 4.05 对 0.49 ± 1.04,平均差 4.38 [95% CI 3.50 至 5.26];p < 0.001)相比,GSW 外伤患者的创伤后应激障碍平均分(± SD)更高。当创伤后应激障碍筛查结果为阳性或阴性时,与非GSW创伤患者(27% [116例中的31例],相对风险2.40 [95% CI 1.64至3.51];p <0.001)和择期手术患者(4% [95例中的4例],相对风险15.22 [95% CI 5.67至40.87];p <0.001)相比,GSW创伤患者患创伤后应激障碍的风险更高(64% [39例中的25例])。只有非GSW创伤患者的疼痛评分与创伤后应激障碍评分相关(ρ = 0.37;p < 0.0001)。GSW患者(ρ = 0.24; p = 0.16)或择期手术患者(ρ = -0.04; p = 0.75)的疼痛评分与创伤后应激障碍评分没有相关性:结论:在骨科门诊人群中,与钝器或其他创伤以及择期骨科疾病相比,枪伤人群中创伤后应激障碍筛查阳性率最高。有趣的是,只有非枪伤创伤患者的疼痛评分与创伤后应激障碍筛查相关。这些差异表明,创伤后出现创伤后应激障碍风险的人群存在很大差异。总体而言,人们对枪支创伤造成的心理影响知之甚少。下一步将是前瞻性地研究与钝器或其他创伤患者相比, GSW 创伤患者的创伤后应激障碍筛查的差异和时限,以更好地确定该人群的治疗需求:证据等级:三级,预后研究。
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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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