Predicting posttraumatic distress in hospitalized trauma survivors with acute injuries.
OBJECTIVE
Each year approximately 2.5 million Americans are hospitalized after sustaining traumatic physical injuries. Few investigations have comprehensively screened for posttraumatic symptomatic distress or identified predictors of posttraumatic stress disorder (PTSD) in representative samples of surgical inpatients.


METHODS
The subjects were 101 randomly selected survivors of motor vehicle crashes or assaults who were interviewed while hospitalized and 1, 4, and 12 months after injury. In the surgical ward, inpatients were screened for PTSD, depressive, and dissociative symptoms, for prior trauma, for pre-event functioning, and for alcohol and drug intoxication. Patient demographic and injury characteristics were also recorded. Random coefficient regression models were used to assess the association between these clinical, injury, and demographic characteristics and PTSD symptom levels over the year after the injury.


RESULTS
Of the 101 surgical inpatients, 73% screened positive for high levels of symptomatic distress and/or substance intoxication. At 1, 4, and 12 months after the injury, 30%-40% reported symptoms consistent with a diagnosis of PTSD. High ward PTSD symptom levels were the strongest and most parsimonious predictor of persistent symptoms over the course of the year. Greater prior trauma, stimulant intoxication, and female gender were also associated with higher symptom levels. Increasing injury severity, however, was not associated with higher PTSD symptom levels.


CONCLUSIONS
Clinical and demographic characteristics readily identifiable at the time of surgical inpatient hospitalization predict PTSD symptoms over the year after injury. Effectiveness trials that test screening and intervention procedures for at-risk inpatients should be developed.
Zatzick
Douglas F
DF
Department of Psychiatry, University of California-Davis, USA. dzatick@u.washington.edu
Kang
Sun-Mee
SM
Müller
Hans-Georg
HG
Russo
Joan E
JE
Rivara
Frederick P
FP
Katon
Wayne
W
Jurkovich
Gregory J
GJ
Roy-Byrne
Peter
P
D000063:Accidents, Traffic / Q000523:psychology / Q000706:statistics & numerical data; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D010555:Personality Inventory; D010641:Phenotype; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology