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Open Access

Post-traumatic stress disorder can be predicted in hospitalized blunt trauma patients using a simple screening tool

Saad Rahmat, Jessica Velez, Muhammad Farooqi, Abbas Smiley, Kartik Prabhakaran, Peter Rhee, Rhea Dornbush, Stephen Ferrando, Yvette Smolin
DOI: 10.1136/tsaco-2020-000623 Published 23 March 2021
Saad Rahmat
1Department of Psychiatry and Behavioral Sciences, Westchester Medical Center, Valahlla, NY, USA
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Jessica Velez
2Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
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Muhammad Farooqi
3Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
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Abbas Smiley
4Department of Surgery, New York Medical College, Valhalla, New York, USA
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Kartik Prabhakaran
2Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
4Department of Surgery, New York Medical College, Valhalla, New York, USA
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Peter Rhee
2Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
4Department of Surgery, New York Medical College, Valhalla, New York, USA
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Rhea Dornbush
3Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
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Stephen Ferrando
3Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
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Yvette Smolin
3Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
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  • Figure 1
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    Figure 1

    Post-traumatic stress disorder diagnostic criteria.

  • Figure 2
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    Figure 2

    Modified consort flow diagram. NSESS, National Stressful Events Survey Acute Stress Disorder Scale; PSSI-5, Posttraumatic Stress Disorder Symptoms Scale Interview for DSM-5.

  • Figure 3
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    Figure 3

    Non-linear multivariable regression modeling. ISS, Injury Severity Score; NSESSS, National Stressful Events Survey Acute Stress Disorder Scale; PTSD, post-traumatic stress disorder EDF, estimated degrees of freedom.

Tables

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  • Table 1

    Demographics

    EnrolledCompleted PSSI-5Level II trauma
    activations (with ISS)
    Gender (%)M: 63.1, F: 36.9M: 61.0, F: 39.0M: 63.0, F: 37.0
    n103591183
    Median age (years)585851
    Mean age±SD (years)55.0±22.455.0±22.752.0±23
    Race (%)
     White72.878.067.0
     Black15.510.29.8
     Asian3.93.41.4
     Other7.88.520.6
     Unknown0.00.00.8
    Ethnicity (%)
     Non-Hispanic93.293.277.4
     Hispanic6.86.820.7
     Unknown0.00.01.9
    Mean ISS±SD11.68±6.8311.45±7.08 (collected for 55/59)10.21±7.72
    Mechanism of injury (%)
     Motor vehicle collision42.742.436.4
     Fall32.030.534.1
     Pedestrian struck9.78.58.5
     Motorcycle collision5.88.56.3
     Bicycle ijury1.01.73.4
     Assault1.01.72.8
     Other7.86.88.5
    Proportion of patients with AIS score≥3 (by body region, %)*
     Head12.611.917.3
     Face0.00.00.6
     Neck1.90.01.5
     Thorax24.320.320.5
     Abdomen4.96.83.8
     Spine9.76.87.6
     Upper extremity1.91.71.0
     Lower extremity19.418.612.2
     External and other0.00.00.0
    • *AIS scores: 1, minor; 2, moderate; 3, serious; 4, severe; 5, critical; 6, maximum.

    • AIS, Abbreviated Injury Scale; F, female; ISS, Injury Severity Score; M, male; PSSI-5, Posttraumatic Stress Disorder Symptoms Scale Interview for DSM-5.

  • Table 2

    Ability of screening tools to predict PTSD diagnosis

    Univariable logistic regressionMultivariable logistic regression (R2=0.058)
    OR (95% CI)P valueOR (95% CI)P value
    Age (years)0.997 (0.967 to 1.028)0.8520.999 (0.966 to 1.034)0.961
    Gender1.053 (0.251 to 4.224)0.9420.958 (0.210 to 4.373)0.956
    ISS1.023 (0.931 to 1.123)0.6391.024 (0.929 to 1.130)0.629
    Initial question2.316 (0.831 to 6.456)0.1082.360 (0.814 to 6.847)0.114
     Univariable logistic regressionMultivariable logistic regression (R2=0.141)
    Age (years)0.997 (0.967 to 1.028)0.8521.004 (0.967 to 1.042)0.836
    Gender1.053 (0.251 to 4.224)0.9420.834 (0.152 to 4.568)0.834
    ISS1.023 (0.931 to 1.123)0.6391.034 (0.935 to 1.143)0.513
    NSESSS-1 (3–5 days)2.745 (1.312 to 5.744)0.0072.982 (1.326 to 6.705)0.008
     Univariable logistic regressionMultivariable logistic regression (R2=0.125)
    Age (years)0.997 (0.967 to 1.028)0.8520.993 (0.953 to 1.036)0.752
    Gender1.053 (0.251 to 4.224)0.9420.590 (0.084 to 4.159)0.597
    ISS1.023 (0.931 to 1.123)0.6391.052 (0.937 to 1.182)0.392
    NSESSS-2 (2–4 weeks)2.988 (1.064 to 8.389)0.0383.707 (1.137 to 12.841)0.039
    • ISS, Injury Severity Score; NSESSS, National Stressful Events Survey Acute Stress Disorder Scale; PTSD, post-traumatic stress disorder.

  • Table 3

    Ability of screening tools to predict PTSD symptom scale (severity)

    Univariable linear regressionMultivariable linear regression (R2=0.111)
    Beta estimate (95% CI)P valueBeta estimate (95% CI)P value
    Age (years)−0.046 (−0.206 to 0.114)0.567−0.061 (−0.236 to 0.113)0.484
    Gender−3.140 (−10.516 to 4.235)0.397−3.718 (−11.787 to 4.350)0.359
    ISS0.035 (−0.517 to 0.588)0.8990.058 (−0.481 to 0.597)0.83
    Initial question5.047 (0.833 to 9.260)0.025.012 (0.268 to 9.757)0.039
     Univariable linear regressionMultivariable linear regression (R2=0.312)
    Age (years)−0.046 (−0.206 to 0.114)0.567−0.034 (−0.188 to 0.120)0.659
    Gender−3.140 (−10.516 to 4.235)0.397−3.426 (−10.511 to 3.658)0.336
    ISS0.035 (−0.517 to 0.588)0.8990.068 (−0.406 to 0.542)0.775
    NSESSS-1 (3–5 days)8.095 (4.634 to 11.556)0.0000188.480 (4.712 to 12.247)0.000038
     Univariable linear regressionMultivariable linear regression (R2=0.391)
    Age (years)−0.046 (−0.206 to 0.114)0.567−0.064 (−0.228 to 0.100)0.433
    Gender−3.140 (−10.516 to 4.235)0.3973.554 (−11.574 to 2.826)0.226
    ISS0.035 (−0.517 to 0.588)0.8990.200 (−0.270 to 0.669)0.394
    NSESSS-2 (2–4 weeks)9.954 (5.758 to 14.151)0.00002110.134 (5.317 to 13.881)0.000066
    • ISS, Injury Severity Score; NSESSS, National Stressful Events Survey Acute Stress Disorder Scale; PTSD, post-traumatic stress disorder.

Supplementary Materials

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  • Supplementary data

    [tsaco-2020-000623supp001.pdf]

  • Supplementary data

    [tsaco-2020-000623supp002.pdf]

Additional Files

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  • Supplementary Materials
  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
    • Data supplement 2
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Post-traumatic stress disorder can be predicted in hospitalized blunt trauma patients using a simple screening tool
Saad Rahmat, Jessica Velez, Muhammad Farooqi, Abbas Smiley, Kartik Prabhakaran, Peter Rhee, Rhea Dornbush, Stephen Ferrando, Yvette Smolin
Trauma Surg Acute Care Open Mar 2021, 6 (1) e000623; DOI: 10.1136/tsaco-2020-000623

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Post-traumatic stress disorder can be predicted in hospitalized blunt trauma patients using a simple screening tool
Saad Rahmat, Jessica Velez, Muhammad Farooqi, Abbas Smiley, Kartik Prabhakaran, Peter Rhee, Rhea Dornbush, Stephen Ferrando, Yvette Smolin
Trauma Surg Acute Care Open Mar 2021, 6 (1) e000623; DOI: 10.1136/tsaco-2020-000623
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Post-traumatic stress disorder can be predicted in hospitalized blunt trauma patients using a simple screening tool
Saad Rahmat, Jessica Velez, Muhammad Farooqi, Abbas Smiley, Kartik Prabhakaran, Peter Rhee, Rhea Dornbush, Stephen Ferrando, Yvette Smolin
Trauma Surgery & Acute Care Open Mar 2021, 6 (1) e000623; DOI: 10.1136/tsaco-2020-000623
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