[Analysis of the relationship between acute stress disorder or posttraumatic stress disorder and total burn area in adult burn patients based on brain function detection results].

Abstract

Objective: To analyze the relationship between acute stress disorder (ASD) or posttraumatic stress disorder (PTSD) and total burn area in adult burn patients based on brain function detection results. Methods: This study was a cross-sectional survey. From May to September in 2024, 121 adult burn patients admitted to the Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital (hereinafter referred to as this hospital) who met the inclusion criteria were selected as respondents. A self-made general information questionnaire was used to investigate the following information of all patients, including the gender, age, total burn area, abbreviated burn severity index, post-injury investigation time, inhalation injury, intensive care unit (ICU) admission during the shock stage. The burn specific health scale-brief scale was used to investigate the quality of life of all patients. The ASD scale-5 (ASDS-5) was used to investigate the severity of ASD in 62 patients within 3 days to 1 month after injury, and the diagnosis of ASD was made by the psychiatrists of this hospital. The PTSD checklist-5 (PCL-5) was used to investigate the severity of PTSD in 59 patients more than 1 month after injury, and the diagnosis of PTSD was made as before. The functional near-infrared spectroscopy was employed to measure the oxy-hemoglobin integral values (hereinafter referred to as integral values) of Broca's area on both sides, the dorsolateral prefrontal cortex on both sides, and the frontopolar cortex on both sides for all patients. Based on the diagnosis results from psychiatrists, patients within 3 days to 1 month after injury were divided into ASD-positive group and ASD-negative group and the prevalence of ASD was calculated, while patients more than 1 month after injury were divided into PTSD-positive group and PTSD-negative group and the prevalence of PTSD was calculated. The general information, quality of life scores, ASDS-5 scores, PCL-5 scores, and the integral values of the above 6 brain regions of interest were respectively counted for each group of patients. Pearson correlation analysis was employed to evaluate the correlations between the age, total burn area, integral values of the 6 brain regions of interest and the ASDS-5 scores of patients who underwent ASDS-5 assessment, and the correlations between the age, total burn area, integral values of the 6 brain regions of interest and the PCL-5 scores of patients who underwent PCL-5 assessment were evaluated. Based on the results of univariate analysis and clinical significance, the independent influencing factors for the occurrence of ASD or PTSD in adult burn patients were screened out. Results: Based on the ASD diagnosis results, among the 62 patients, 16 patients were included in ASD-positive group and 46 patients were included in ASD-negative group. The prevalence of ASD was 25.8%. There were no statistically significant differences in the general information and quality of life scores between patients in ASD-positive group and ASD-negative group (P>0.05). The ASDS-5 scores of patients in ASD-positive group were significantly higher than those in ASD-negative group (Z=5.96, P<0.05). Based on the PTSD diagnosis results, among the 59 patients, 22 patients were included in PTSD-positive group and 37 patients were included in PTSD-negative group. The prevalence of PTSD was 37.3%. Compared with those in PTSD-negative group, the patients in PTSD-positive group had larger total burn areas, higher abbreviated burn severity indexes and PCL-5 scores, and lower quality of life scores (with Z values of 2.96, 2.91, 6.40, and 4.69, respectively, P<0.05), more patients with inhalation injury, and more ICU admission during shock stage (with χ² values of 9.94 and 8.02, respectively, P<0.05). The integral values of left Broca's area, left dorsolateral prefrontal cortex, left frontopolar cortex, right dorsolateral prefrontal cortex, and right frontopolar cortex of patients in ASD-positive group were significantly lower than those in ASD-negative group (with Z values of 2.24, 2.90, 2.24, 2.30, and 2.40, respectively, P<0.05). There were no statistically significant differences in the integral values of the 6 brain regions of interest between patients in PTSD-positive group and PTSD-negative group (P>0.05). The integral values of the left Broca's area, left dorsolateral prefrontal cortex, left frontopolar cortex, right dorsolateral prefrontal cortex, and right frontopolar cortex of 62 patients who underwent ASDS-5 assessment were significantly negatively correlated with their ASDS-5 scores (with r values of -0.29, -0.37, -0.30, -0.31, and -0.29, respectively, P<0.05). The total burn area of 59 patients who underwent PCL-5 assessment was significantly positively correlated with their PCL-5 scores (r=0.35, P<0.05). The integral value of the left dorsolateral prefrontal cortex was an independent influencing factor for ASD occurrence in adult burn patients (with odds ratio of 0.99, 95% confidence interval of 0.98-1.00, P<0.05). The total burn area was an independent influencing factor for PTSD occurrence in adult burn patients (with odds ratio of 1.04, 95% confidence interval of 1.01-1.06, P<0.05). Conclusions: The prevalence rates of ASD and PTSD are high among adult burn patients. Total burn area is not an independent influencing factor for ASD occurrence, but it is an independent influencing factor for PTSD occurrence in adult burn patients.