Posttraumatic concerns: a patient-centered approach to outcome assessment after traumatic physical injury.
BACKGROUND
Approximately 2.5 million Americans are admitted to the hospital after traumatic physical injury each year. Few investigations have elicited patients' perspectives regarding posttraumatic outcomes.


OBJECTIVE
To identify and categorize physically injured trauma survivors' posttraumatic concerns.


METHODS
Prospective longitudinal investigation; trauma survivors were interviewed during the post-injury hospitalization and again 1, 4, and 12 months after the trauma.


METHODS
Ninety-seven, randomly selected, English speaking, hospitalized survivors of motor vehicle-crashes or assaults.


METHODS
At the end of each interview patients were asked, "Of all the things that have happened to you since you were injured, what concerns you the most?" Using an iterative process and working by consensus, investigators categorized patient concerns in content domains. Concern domains were then compared with established measures of posttraumatic stress disorder (PTSD) symptoms and limitations in physical functioning.


RESULTS
Seven categories of posttraumatic concerns were identified. During the course of the year, 73% of patients expressed physical health concerns, 58% psychological concerns, 53% work and finance concerns, 40% social concerns, 10% legal concerns, 10% medical concerns, and 20% uncodable concerns. Rater agreement on concern categorization was substantial (kappa = 0.72). The mean number of concerns expressed per patient gradually decreased over time (1 month mean = 1.51; 12 month mean = 1.26) and resembled the trajectories of PTSD symptoms and functional limitations.


CONCLUSIONS
The concerns of physically injured trauma survivors are readily elicited and followed up during the course of the year after injury. Open-ended inquiry regarding posttraumatic concerns may complement standardized outcome assessments by identifying and contextualizing the outcomes of greatest importance to patients.
Zatzick
D F
DF
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, 98104-2499, USA. dzatzick@u.washington.edu
Kang
S M
SM
Hinton
W L
WL
Kelly
R H
RH
Hilty
D M
DM
Franz
C E
CE
Le
L
L
Kravitz
R L
RL
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007407:Interviews as Topic; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000523:psychology; D017741:Survivors / Q000523:psychology; D014947:Wounds and Injuries / Q000150:complications* / Q000523:psychology