Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments

Douglas F. Zatzick, Frederick P. Rivara, Gregory Jurkovich, Charles W. Hoge, Jin Wang, Ming Yu Fan, Joan Russo, Sarah Geiss Trusz, Avery Nathens, Ellen J. Mackenzie

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Context: Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI). Objectives: To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity. Design: Multisite US prospective cohort study. Setting: Eighteen level I trauma centers and 51 non-trauma center hospitals. Patients: A total of 3047 (weighted n=10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years. Main Outcome Measures: Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury. Results: At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD. Conclusions: More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.

Original languageEnglish (US)
Pages (from-to)1291-1300
Number of pages10
JournalArchives of General Psychiatry
Volume67
Issue number12
DOIs
StatePublished - Dec 1 2010
Externally publishedYes

Fingerprint

Post-Traumatic Stress Disorders
Health
Brain Concussion
Outcome Assessment (Health Care)
Cognition
Health Status
Cognitive Dysfunction
Traumatic Brain Injury
Cognitive Impairment
Wounds and Injuries
Multiple Trauma
Trauma Centers
International Classification of Diseases
Health Surveys
Checklist
Diagnostic and Statistical Manual of Mental Disorders
Survivors
Hospitalization
Cohort Studies
Prospective Studies

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Psychiatry and Mental health

Cite this

Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments. / Zatzick, Douglas F.; Rivara, Frederick P.; Jurkovich, Gregory; Hoge, Charles W.; Wang, Jin; Fan, Ming Yu; Russo, Joan; Trusz, Sarah Geiss; Nathens, Avery; Mackenzie, Ellen J.

In: Archives of General Psychiatry, Vol. 67, No. 12, 01.12.2010, p. 1291-1300.

Research output: Contribution to journalArticle

Zatzick, Douglas F. ; Rivara, Frederick P. ; Jurkovich, Gregory ; Hoge, Charles W. ; Wang, Jin ; Fan, Ming Yu ; Russo, Joan ; Trusz, Sarah Geiss ; Nathens, Avery ; Mackenzie, Ellen J. / Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments. In: Archives of General Psychiatry. 2010 ; Vol. 67, No. 12. pp. 1291-1300.
@article{5d164955c6cd43fd877d38b45102a395,
title = "Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments",
abstract = "Context: Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI). Objectives: To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity. Design: Multisite US prospective cohort study. Setting: Eighteen level I trauma centers and 51 non-trauma center hospitals. Patients: A total of 3047 (weighted n=10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years. Main Outcome Measures: Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury. Results: At the time of injury hospitalization, 20.5{\%} of patients had severe TBI, 11.7{\%} moderate TBI, 12.9{\%} mild TBI, and 54.9{\%} no TBI. Patients with severe (relative risk, 0.72; 95{\%} confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD. Conclusions: More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.",
author = "Zatzick, {Douglas F.} and Rivara, {Frederick P.} and Gregory Jurkovich and Hoge, {Charles W.} and Jin Wang and Fan, {Ming Yu} and Joan Russo and Trusz, {Sarah Geiss} and Avery Nathens and Mackenzie, {Ellen J.}",
year = "2010",
month = "12",
day = "1",
doi = "10.1001/archgenpsychiatry.2010.158",
language = "English (US)",
volume = "67",
pages = "1291--1300",
journal = "JAMA Psychiatry",
issn = "2168-622X",
publisher = "American Medical Association",
number = "12",

}

TY - JOUR

T1 - Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments

AU - Zatzick, Douglas F.

AU - Rivara, Frederick P.

AU - Jurkovich, Gregory

AU - Hoge, Charles W.

AU - Wang, Jin

AU - Fan, Ming Yu

AU - Russo, Joan

AU - Trusz, Sarah Geiss

AU - Nathens, Avery

AU - Mackenzie, Ellen J.

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Context: Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI). Objectives: To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity. Design: Multisite US prospective cohort study. Setting: Eighteen level I trauma centers and 51 non-trauma center hospitals. Patients: A total of 3047 (weighted n=10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years. Main Outcome Measures: Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury. Results: At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD. Conclusions: More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.

AB - Context: Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI). Objectives: To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity. Design: Multisite US prospective cohort study. Setting: Eighteen level I trauma centers and 51 non-trauma center hospitals. Patients: A total of 3047 (weighted n=10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years. Main Outcome Measures: Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury. Results: At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD. Conclusions: More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.

UR - http://www.scopus.com/inward/record.url?scp=78649965872&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78649965872&partnerID=8YFLogxK

U2 - 10.1001/archgenpsychiatry.2010.158

DO - 10.1001/archgenpsychiatry.2010.158

M3 - Article

C2 - 21135329

AN - SCOPUS:78649965872

VL - 67

SP - 1291

EP - 1300

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

IS - 12

ER -