Long-term posttraumatic stress disorder persists after major trauma in adolescents: New data on risk factors and functional outcome

Troy L. Holbrook, David B. Hoyt, Raul Coimbra, Bruce Potenza, Michael Sise, John P. Anderson, Lenworth M. Jacobs, Arthur Cooper, David A. Spain, Gregory Jurkovich, Grace S. Rozycki, Palmer O. Bessey

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123 Scopus citations

Abstract

Background: Little is Known about long-term psychological outcomes after major trauma in adolescents, a leading cause of death and preventable morbidity in this age group. A prospective epidemiologic study was conducted to examine quality of life (QoL) and posttraumatic stress disorder (PTSD) outcomes in injured adolescents. The specific objectives of the present report are to describe long-term PTSD and to identify risk factors for long-term PTSD and the impact of PTSD on QoL. Methods: Between April 26, 1999, and November 13, 2002, 401 eligible trauma patients aged 12 to 19 years tri-aged to five participating trauma center hospitals in a regionalized trauma system were enrolled in the study. The admission criteria for patients were as follows: age 12 to 19 years and injury diagnoses excluding severe traumatic brain injury or spinal cord injury. PTSD was diagnosed with the Impact of Events Scale-Revised; scores of 24+ were used to diagnose PTSD. QoL after trauma was measured using the Quality of Well-Being scale, a sensitive and well-validated functional index (range: 0 = death to 1.000 = optimum functioning). Patient outcomes were assessed at discharge and at 3, 6, 12, 18, and 24 months after discharge. Results: The rate of long-term PTSD was 27%, with high rates over the follow-up period. Risk factors for long-term PTSD were perceived threat to life (odds ratio [OR], 2.2; p < 0.001.); death of a family member at the scene (OR, 4.7; p < 0.001); no control over injury event (OR, 1.7; p < 0.05), and violence-related injury (OR, 2.2; p < 0.05). PTSD in adolescents was significantly and strongly associated with female gender, older age, low socioeconomic status, drug and alcohol abuse, and other adolescent behavioral problems. Long-term PTSD was also associated with marked and significant QoL deficits throughout the 24-month follow-up interval. Conclusion: High rates of long-term PTSD persist after major trauma in adolescents. Injury events such as perceived threat to life and control over the event are strongly associated with PTSD risk. Prolonged PTSD severely impacts QoL outcomes. Early identification and treatment of risk factors for long-term PTSD will be important to improve outcomes in injured adolescents.

Original languageEnglish (US)
Pages (from-to)764-771
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume58
Issue number4
DOIs
StatePublished - Apr 1 2005
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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    Holbrook, T. L., Hoyt, D. B., Coimbra, R., Potenza, B., Sise, M., Anderson, J. P., Jacobs, L. M., Cooper, A., Spain, D. A., Jurkovich, G., Rozycki, G. S., & Bessey, P. O. (2005). Long-term posttraumatic stress disorder persists after major trauma in adolescents: New data on risk factors and functional outcome. Journal of Trauma - Injury, Infection and Critical Care, 58(4), 764-771. https://doi.org/10.1097/01.TA.0000159247.48547.7D