title: Glasgow Coma Scale scores, early opioids, and 4-year psychological  outcomes among combat amputees.
abstract: Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV) morphine (vs IV fentanyl) after injury was associated with reduced likelihood of posttraumatic stress disorder (PTSD). The previous results were based on military health diagnoses over 2 yr postinjury. The present study followed psychological diagnoses of patients with amputation for 4 yr using military and Department of Veterans Affairs health data. In-theater combat casualty records (n = 145) documented Glasgow Coma Scale (GCS) scores and/or morphine, fentanyl, or no opioid treatment within hours of injury. We found that (1) GCS scores were not significantly associated with PTSD; (2) longitudinal modeling using four (yearly) time points showed significantly reduced odds of PTSD for patients treated with morphine (vs fentanyl) across years (adjusted odds ratio = 0.40; 95% confidence interval = 0.17–0.94); (3) reduced PTSD prevalence for morphine (vs IV fentanyl; morphine = 25%, fentanyl = 59%, p < 0.05) was significant, specifically among patients with traumatic brain injury during the first 2 yr postinjury; and (4) PTSD prevalence, but not other disorders (e.g., mood), increased between year 1 (PTSD = 18%) and years 2 through 4 postinjury (PTSD range = 30%–32%).
authors.forename: Ted
authors.initials: T
authors.lastname: Melcer
authors.forename: Jay
authors.initials: J
authors.lastname: Walker
authors.forename: Vibha
authors.initials: V
authors.lastname: Bhatnagar
authors.forename: Erin
authors.initials: E
authors.lastname: Richard
authors.forename: Peggy
authors.initials: P
authors.lastname: Han
authors.forename: V  Franklin
authors.initials: V
authors.lastname: Sechriest
authors.forename: Martin
authors.initials: M
authors.lastname: Lebedda
authors.forename: Kimberly
authors.initials: K
authors.lastname: Quinn
authors.forename: Michael
authors.initials: M
authors.lastname: Galarneau
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical / Q000523:psychology*; D000673:Amputation, Traumatic / Q000188:drug therapy* / Q000523:psychology; D000674:Amputees / Q000523:psychology*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001930:Brain Injuries / Q000453:epidemiology; D005283:Fentanyl / Q000008:administration & dosage*; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008137:Longitudinal Studies; D008889:Military Personnel / Q000523:psychology*; D009020:Morphine / Q000008:administration & dosage*; D015995:Prevalence; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D013997:Time Factors; D014474:Unconsciousness / Q000453:epidemiology; D014481:United States; D014728:Veterans / Q000523:psychology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl