title: Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors.
abstract: OBJECTIVE
  To assess intensive care unit (ICU)/acute care service-delivery characteristics and pre-ICU factors as predictors of posttraumatic stress disorder (PTSD) and return to usual major activity after ICU admission for trauma.
  
  
  METHODS
  Data from the National Study on the Costs and Outcomes of Trauma were used to evaluate a prospective cohort of 1906 ICU survivors. We assessed PTSD with the PTSD Checklist. Regression analyses ascertained associations between ICU/acute care service-delivery characteristics, pre-ICU factors, early post-ICU distress and 12-month PTSD and return to usual activity, while controlling for clinical and demographic characteristics.
  
  
  RESULTS
  Approximately 25% of ICU survivors had symptoms suggestive of PTSD. Increased early post-ICU distress predicted both PTSD and diminished usual major activity. Pulmonary artery catheter insertion [risk ratio (RR) 1.28, 95% confidence interval (95% CI) 1.05-1.57, P=.01] and pre-ICU depression (RR 1.23, 95% CI 1.02-1.49, P=.03) were associated with PTSD. Longer ICU lengths of stay (RR 1.21, 95% CI 1.03-1.44, P=.02) and tracheostomy (RR 1.29, 95% CI 1.05-1.59, P=.01) were associated with diminished usual activity. Greater preexisting medical comorbidities were associated with PTSD and limited return to usual activity.
  
  
  CONCLUSIONS
  Easily identifiable risk factors including ICU/acute care service-delivery characteristics and early post-ICU distress were associated with increased risk of PTSD and limitations in return to usual major activity. Future investigations could develop early screening interventions in acute care settings targeting these risk factors, facilitating appropriate treatments.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104, USA. ddavydo1@u.washington.edu
authors.forename: Dimitry S
authors.initials: DS
authors.lastname: Davydow
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Zatzick
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Peter P
authors.initials: PP
authors.lastname: Roy-Byrne
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.forename: Erin K
authors.initials: EK
authors.lastname: Kross
authors.forename: Ming-Yu
authors.initials: MY
authors.lastname: Fan
authors.forename: Jutta
authors.initials: J
authors.lastname: Joesch
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: MacKenzie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005544:Forecasting; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D017741:Survivors / Q000523:psychology*; D014481:United States; D014947:Wounds and Injuries / Q000523:psychology*; D055815:Young Adult
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