title: Prospective Evaluation of Posttraumatic Stress Disorder in Injured Patients With and Without Orthopaedic Injury.
abstract: OBJECTIVE
  The study purposes were to prospectively evaluate occurrence of posttraumatic stress (PTS) symptoms at hospital admission and 6 months later in patients with orthopaedic injury; to explore differences in PTS symptoms in those with and without orthopaedic injury; and to determine whether PTS symptoms are influenced by orthopaedic injury type.
  
  
  METHODS
  Prospective, longitudinal observational study.
  
  
  METHODS
  Level 1 Trauma Center.
  
  
  METHODS
  Two hundred fifty-nine participants admitted for at least 24 hours.
  
  
  METHODS
  The Primary Care Posttraumatic Stress Disorder (PTSD) Screen (PC-PTSD) measured PTSD symptoms during hospitalization. The PTSD Checklist-Civilian Version (PCL-C) measured PTS symptoms at 6 months.
  
  
  RESULTS
  In orthopaedic patients, 28% had PTS at 6 months, compared with 34% of nonorthopaedic patients. Odds ratios (ORs) were calculated to determine the influence of pain, physical and mental function, depression, and work status. At 6 months, if the pain score was 5 or higher, the odds of PTS symptoms increased to 8.38 (3.55, 19.8) (P < 0.0001). Those scoring below average in physical function were significantly more likely to have PTS symptoms [OR = 7.60 (2.99, 19.32), P < 0.0001]. The same held true for mental functioning and PTS [OR = 11.4 (4.16, 30.9), P < 0.0001]. Participants who screened positive for depression had a 38.9 (14.5, 104) greater odds (P < 0.0001). Participants who did not return to work after injury at 6 months were significantly more likely to have PTS [OR = 16.5 (1.87, 146), P = 0.012].
  
  
  CONCLUSIONS
  PTSD is common in patients after injury, including those with orthopaedic trauma. At 6 months, pain of 5 or greater, poor physical and mental function, depression, and/or not returning to work seem to be predictive of PTSD. Orthopaedic surgeons should identify and refer for PTSD treatment given the high incidence postinjury.
  
  
  METHODS
  Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Baylor University Medical Center; †Baylor Scott and White; and ‡Baylor Research Institute.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Warren
authors.forename: Alan L
authors.initials: AL
authors.lastname: Jones
authors.forename: Monica
authors.initials: M
authors.lastname: Bennett
authors.forename: Jaicus K
authors.initials: JK
authors.lastname: Solis
authors.forename: Megan
authors.initials: M
authors.lastname: Reynolds
authors.forename: Evan E
authors.initials: EE
authors.lastname: Rainey
authors.forename: Grace
authors.initials: G
authors.lastname: Viere
authors.forename: Michael L
authors.initials: ML
authors.lastname: Foreman
mesh_terms: D015984:Causality; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D062707:Return to Work / Q000706:statistics & numerical data*; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D013781:Texas / Q000453:epidemiology