Tag Archives: PTSD

General

Trauma Surgeons And PTSD??

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A number of studies have documented post-traumatic stress disorder in our trauma patients, pre-hospital providers, and combat veterans. A new study now suggests that PTSD symptoms are present in 41% of trauma surgeons(!). Can it be true??

The study was carried out using an email questionnaire that was sent to all EAST and AAST members. Respondents were directed to an online questionnaire that polled them for basic demographics, as well as a series of questions using a well-established PTSD checklist scale, the PCL-C.

Here are the factoids:

  • 1104 questionnaires were distributed, and 453 were complete enough for analysis (41%)
  • Respondents tended to be younger (68% < 50 years old), male (76%) and white (80%)
  • The majority worked in Level I (71%) urban (90%) academic centers (81%) with resident coverage (83%)
  • 85% took at least 4 in-house calls each month, 27% had 2 weeks or less of vacation each year (!), and 81% believed that trauma surgery was more stressful than other surgical subspecialties
  • 40% of respondents had PCL scores consistent with PTSD (!)
  • The only independent predictor of having PTSD symptoms was managing 5 or more critical cases while on call

Bottom line: Hmm, be skeptical of this one. Yes, it does seem to show some possible issues with PTSD in a select group of trauma surgeons. However, I don’t believe this is easily generalized, and my personal contact with surgeons around the country does not really bear this out. The survey methodology, response rate, and the skewed demographics raise some serious questions about the quality of this data. And can self-reporting of PTSD symptoms from a group of trauma surgeons really be reliable?? It does appear that a subset of surgeons who work at very busy urban centers may be at risk, and this certainly deserves further scrutiny. But this study does not really apply to the majority of surgeons practicing trauma care in this country, who don’t work in that kind of environment.

Related posts:

Reference: Unveiling posttraumatic stress disorder in trauma surgeons: A national survey. J Trauma 77(1):148-154, 2014.

General

AAST 2011: Predicting Post-Traumatic Stress Disorder (PTSD) After Trauma

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Today is the last day of the annual AAST meeting, so I’ll wind up with one last abstract presented at this meeting.

PTSD can cause significant morbidity after trauma. Most centers manage this problem reactively, when the patient exhibits obvious symptoms in the hospital or after discharge. Wouldn’t it make more sense to screen for it routinely? Is there a way to figure out which patients are at higher risk?

The University of Pittsburgh prospectively screened 1,386 injured patients presenting to their followup clinic using the PTSD Checklist – Civilian (PCL-C) instrument. A score of>=35 has a sensitivity of 85% and was considered a positive result.

The authors found that more than 25% of their outpatient clinic patients met the threshold. The most common mechanism was assault, both blunt and penetrating. Younger age (<55), female gender and motor vehicle crash were also found to be predictors.

Bottom line: Consider routine PTSD screening in patients with the listed risk factors, just like we perform routine TBI screening in patients with head injuries. The PCL-C is self-administered and takes only about 5 minutes to complete. The most reliable way is to send it home with your patient, with instructions to complete it before they see you or their primary physician in the outpatient clinic.

Resources:

Reference: Predictors of post-traumatic stress disorder (PTSD) following civilian trauma: highest incidence and severity of symptoms after assault. AAST 2011 Annual Meeting, Paper 33.