Timothy F Platts-Mills1, Bo C Nebolisa2, Sean A Flannigan3, Natalie L Richmond2, Robert M Domeier4, Robert A Swor5, Phyllis L Hendry6, David A Peak7, Niels K Rathlev8, Jeffrey S Jones9, David C Lee10, Christopher W Jones11, Samuel A McLean12. 1. Department of Anesthesiology, University of North Carolina, Chapel Hill, NC; Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC. Electronic address: tplattsm@med.unc.edu. 2. School of Medicine, University of North Carolina, Chapel Hill, NC. 3. Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC. 4. Department of Emergency Medicine, St. Joseph Mercy Health System, Ann Arbor, MI. 5. Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI. 6. Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL. 7. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA. 8. Department of Emergency Medicine, Baystate Medical Center, Springfield, MA. 9. Department of Emergency Medicine, Spectrum Health-Butterworth Campus, Grand Rapids, MI. 10. Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY. 11. Department of Emergency Medicine, Cooper University Hospital, Camden, NJ. 12. Department of Anesthesiology, University of North Carolina, Chapel Hill, NC; Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC.
Abstract
OBJECTIVE: To characterize risk factors for and consequences of post-traumatic stress disorder (PTSD) among older adults evaluated in the emergency department (ED) following motor vehicle collision (MVC). DESIGN: Prospective multicenter longitudinal study (2011-2015). SETTING: 9 EDs across the United States. PARTICIPANTS: Adults aged 65 years and older who presented to an ED after MVC without severe injuries. MEASUREMENTS: PTSD symptoms were assessed 6 months after the ED visit using the Impact of Event Scale-Revised. RESULTS: Of 223 patients, clinically significant PTSD symptoms at 6 months were observed in 21% (95% CI 16%-26%). PTSD symptoms were more common in patients who did not have a college degree, had depressive symptoms prior to the MVC, perceived the MVC as life-threatening, had severe ED pain, and expected their physical or emotional recovery time to be greater than 30 days. Three factors (ED pain severity [0-10 scale], perceived life-threatening MVC [0-10 scale], and pre-MVC depressive symptoms [yes to either of two questions]), predicted 6-month PTSD symptoms with an area under the curve of 0.76. Compared to patients without PTSD symptoms, those with PTSD symptoms were at higher risk for persistent pain (72% versus 30%), functional decline (67% versus 42%), and new disability (49% versus 18%). CONCLUSIONS: Among older adults treated in the ED following MVC, clinically significant PTSD symptoms at 6 months were present in 21% of patients and were associated with adverse health outcomes. Increased risk for PTSD development can be identified with moderate accuracy using information readily available in the ED.
OBJECTIVE: To characterize risk factors for and consequences of post-traumatic stress disorder (PTSD) among older adults evaluated in the emergency department (ED) following motor vehicle collision (MVC). DESIGN: Prospective multicenter longitudinal study (2011-2015). SETTING: 9 EDs across the United States. PARTICIPANTS: Adults aged 65 years and older who presented to an ED after MVC without severe injuries. MEASUREMENTS: PTSD symptoms were assessed 6 months after the ED visit using the Impact of Event Scale-Revised. RESULTS: Of 223 patients, clinically significant PTSD symptoms at 6 months were observed in 21% (95% CI 16%-26%). PTSD symptoms were more common in patients who did not have a college degree, had depressive symptoms prior to the MVC, perceived the MVC as life-threatening, had severe ED pain, and expected their physical or emotional recovery time to be greater than 30 days. Three factors (ED pain severity [0-10 scale], perceived life-threatening MVC [0-10 scale], and pre-MVC depressive symptoms [yes to either of two questions]), predicted 6-month PTSD symptoms with an area under the curve of 0.76. Compared to patients without PTSD symptoms, those with PTSD symptoms were at higher risk for persistent pain (72% versus 30%), functional decline (67% versus 42%), and new disability (49% versus 18%). CONCLUSIONS: Among older adults treated in the ED following MVC, clinically significant PTSD symptoms at 6 months were present in 21% of patients and were associated with adverse health outcomes. Increased risk for PTSD development can be identified with moderate accuracy using information readily available in the ED.
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Authors: Timothy F Platts-Mills; Lauren Ballina; Andrey V Bortsov; April Soward; Robert A Swor; Jeffrey S Jones; David C Lee; David A Peak; Robert M Domeier; Niels K Rathlev; Phyllis L Hendry; Samuel A McLean Journal: BMC Emerg Med Date: 2011-09-26