title: Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury.
abstract: Post-traumatic stress disorder (PTSD) is a condition associated with traumatic brain injury (TBI). While the importance of PTSD and TBI among military personnel is widely recognized, there is less awareness of PTSD associated with civilian TBI. We examined the incidence and factors associated with PTSD 6 months post-injury in a civilian emergency department population using measures from the National Institute of Neurological Disorders and Stroke TBI Common Data Elements Outcome Battery. Participants with mild TBI (mTBI) from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with complete 6-month outcome batteries (n = 280) were analyzed. Screening for PTSD symptoms was conducted using the PTSD Checklist-Civilian Version. Descriptive measures are summarized and predictors for PTSD were examined using logistic regression. Incidence of screening positive for PTSD was 26.8% at 6 months following mTBI. Screening positive for PTSD was significantly associated with concurrent functional disability, post-concussive and psychiatric symptomatology, decreased satisfaction with life, and decreased performance in visual processing and mental flexibility. Multi-variable regression showed injury mechanism of assault (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.69-7.63; p = 0.001) and prior psychiatric history (OR 2.56; 95% CI 1.42-4.61; p = 0.002) remained significant predictors of screening positive for PTSD, while education (per year OR 0.88; 95% CI 0.79-0.98; p = 0.021) was associated with decreased odds of PTSD. Standardized data collection and review of pre-injury education, psychiatric history, and injury mechanism during initial hospital presentation can aid in identifying patients with mTBI at risk for developing PTSD symptoms who may benefit from closer follow-up after initial injury care.
authors.affiliation: 1 Division of Unintentional Injury, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Juliet
authors.initials: J
authors.lastname: Haarbauer-Krupa
authors.affiliation: 1 Division of Unintentional Injury, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Taylor
authors.affiliation: 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.|3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California.
authors.forename: John K
authors.initials: JK
authors.lastname: Yue
authors.affiliation: 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.|3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Winkler
authors.affiliation: 4 Department of Anesthesia and Perioperative Care, University of California , San Francisco, San Francisco, California.
authors.forename: Romain
authors.initials: R
authors.lastname: Pirracchio
authors.affiliation: 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.|3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California.|5 Department of Psychology, Washington University in St. Louis , St. Louis, Missouri.
authors.forename: Shelly R
authors.initials: SR
authors.lastname: Cooper
authors.affiliation: 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.|3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California.
authors.forename: John F
authors.initials: JF
authors.lastname: Burke
authors.affiliation: 6 Department of Psychiatry, University of California , San Diego, San Diego, California.|7 Department of Family and Preventive Medicine, University of California , San Diego, San Diego, California.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.affiliation: 2 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.|3 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California.
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Manley
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy
keywords: emergency department screening; post-traumatic stress disorder; traumatic brain injury