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Acute stress disorder in trauma patients discharged in 72 h or less

  • Aaron C Veenis
    Affiliations
    Department of Surgery, Division of Trauma/Critical Care & Acute Surgery, The University of Kansas Health System, 4000 Cambridge St, MS 2005, Kansas City KS 66160
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  • Bachar N Halimeh
    Affiliations
    Department of Surgery, Division of Trauma/Critical Care & Acute Surgery, The University of Kansas Health System, 4000 Cambridge St, MS 2005, Kansas City KS 66160
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  • Robert D Winfield
    Correspondence
    Corresponding author at: Associate Professor of Surgery, Division Chief, Acute Care Surgery, Trauma, and Surgical Critical Care Director of Trauma Research University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 2005, Kansas City, KS 66160-8501.
    Affiliations
    Department of Surgery, Division of Trauma/Critical Care & Acute Surgery, The University of Kansas Health System, 4000 Cambridge St, MS 2005, Kansas City KS 66160
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      Highlights

      • Trauma patients are at an elevated risk of developing acute stress disorder and trauma patients discharged prior to 72 h often are not screened.
      • Our study found a significant number of trauma patients discharged in 72 h or less developed acute stress disorder following discharge.
      • Despite injuries requiring shorter hospitalizations, our data supports the reassessment of trauma patients following hospital discharge.
      • Widely accessible pathways need to be developed to increased patient access to mental health resources.

      Abstract

      Introduction

      Acute Stress Disorder (ASD) is a psychiatric condition affecting individuals exposed to trauma and requires the presence of symptoms 72 h following trauma. Patients evaluated for trauma related injury are often discharged prior to 72 h, but the risk of ASD remains. The aim of this study was to quantify the rate of acute stress disorder in trauma patients admitted for fewer than 72 h.

      Materials and Methods

      We performed a prospective, observational study of trauma patients discharged prior to 72 h at our ACS Level I Trauma Center between June 2020 and December 2020. Participants were administered an institutional screening tool following hospital discharge. Positive screens were then administered the diagnostic Acute Stress Disorder Scale (ASDS) tool. The rate of ASD was calculated and bivariate comparisons between participants who met diagnostic criteria and those who did not were performed to identify risk factors for the development of acute stress disorder.

      Results

      116 patients participated (median age 54, 66% male, median injury severity score (ISS) 9). Forty patients (34%) screened positive via the institutional screening tool, with 14 (12%) ultimately demonstrating ASD by ASDS. Participants who developed ASD were more likely to be female (71 vs. 30%, p = 0.005), African American (43 vs. 12% White, p = 0.016), spend less time in the hospital overall (1–2 vs. 2–3 days. p = 0.045), and have a lower ISS (6 vs. 9, p = 0.041).

      Conclusions

      Our study found 12% of trauma patients discharged prior to 72 h developed ASD. These data point to possible benefit in reassessment of injured patients following hospital discharge and the importance of developing pathways for trauma patients to access mental health resources.

      Keywords

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