Posttraumatic concerns

A patient-centered approach to outcome assessment after traumatic physical injury

Douglas F. Zatzick, Sun Mee Kang, W Ladson Hinton, Rosemary H. Kelly, Donald M. Hilty, Carol E. Franz, Leanne Le, Richard L Kravitz

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

BACKGROUND. Approximately 2.5 million Americans are admitted to the hospital after traumatic physical injury each year. Few investigations have elicited patients' perspectives regarding posttraumatic outcomes. OBJECTIVE. To identify and categorize physically injured trauma survivors' posttraumatic concerns. RESEARCH DESIGN. Prospective longitudinal investigation; trauma survivors were interviewed during the post-injury hospitalization and again 1, 4, and 12 months after the trauma. SUBJECTS. Ninety-seven, randomly selected, English speaking, hospitalized survivors of motor vehicle-crashes or assaults. MEASURES. At the end of each interview patients were asked, "Of all the things that have happened to you since you were injured, what concerns you the most?" Using an iterative process and working by consensus, investigators categorized patient concerns in content domains. Concern domains were then compared with established measures of posttraumatic stress disorder (PTSD) symptoms and limitations in physical functioning. RESULTS. Seven categories of posttraumatic concerns were identified. During the course of the year, 73% of patients expressed physical health concerns, 58% psychological concerns, 53% work and finance concerns, 40% social concerns, 10% legal concerns, 10% medical concerns, and 20% uncodable concerns. Rater agreement on concern categorization was substantial (κ = 0.72). The mean number of concerns expressed per patient gradually decreased over time (1 month mean = 1.51; 12 month mean = 1.26) and resembled the trajectories of PTSD symptoms and functional limitations. CONCLUSIONS. The concerns of physically injured trauma survivors are readily elicited and followed up during the course of the year after injury. Open-ended inquiry regarding post-traumatic concerns may complement standardized outcome assessments by identifying and contextualizing the outcomes of greatest importance to patients.

Original languageEnglish (US)
Pages (from-to)327-339
Number of pages13
JournalMedical Care
Volume39
Issue number4
DOIs
StatePublished - Apr 2001

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trauma
Outcome Assessment (Health Care)
Wounds and Injuries
posttraumatic stress disorder
Survivors
Post-Traumatic Stress Disorders
assault
hospitalization
motor vehicle
speaking
finance
Motor Vehicles
interview
health
Consensus
Hospitalization
Research Personnel
Interviews
Psychology
Health

Keywords

  • Outcome assessment
  • Patient-centered care
  • PTSD
  • Qualitative research
  • Trauma

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Posttraumatic concerns : A patient-centered approach to outcome assessment after traumatic physical injury. / Zatzick, Douglas F.; Kang, Sun Mee; Hinton, W Ladson; Kelly, Rosemary H.; Hilty, Donald M.; Franz, Carol E.; Le, Leanne; Kravitz, Richard L.

In: Medical Care, Vol. 39, No. 4, 04.2001, p. 327-339.

Research output: Contribution to journalArticle

Zatzick, Douglas F. ; Kang, Sun Mee ; Hinton, W Ladson ; Kelly, Rosemary H. ; Hilty, Donald M. ; Franz, Carol E. ; Le, Leanne ; Kravitz, Richard L. / Posttraumatic concerns : A patient-centered approach to outcome assessment after traumatic physical injury. In: Medical Care. 2001 ; Vol. 39, No. 4. pp. 327-339.
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AU - Hilty, Donald M.

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N2 - BACKGROUND. Approximately 2.5 million Americans are admitted to the hospital after traumatic physical injury each year. Few investigations have elicited patients' perspectives regarding posttraumatic outcomes. OBJECTIVE. To identify and categorize physically injured trauma survivors' posttraumatic concerns. RESEARCH DESIGN. Prospective longitudinal investigation; trauma survivors were interviewed during the post-injury hospitalization and again 1, 4, and 12 months after the trauma. SUBJECTS. Ninety-seven, randomly selected, English speaking, hospitalized survivors of motor vehicle-crashes or assaults. MEASURES. At the end of each interview patients were asked, "Of all the things that have happened to you since you were injured, what concerns you the most?" Using an iterative process and working by consensus, investigators categorized patient concerns in content domains. Concern domains were then compared with established measures of posttraumatic stress disorder (PTSD) symptoms and limitations in physical functioning. RESULTS. Seven categories of posttraumatic concerns were identified. During the course of the year, 73% of patients expressed physical health concerns, 58% psychological concerns, 53% work and finance concerns, 40% social concerns, 10% legal concerns, 10% medical concerns, and 20% uncodable concerns. Rater agreement on concern categorization was substantial (κ = 0.72). The mean number of concerns expressed per patient gradually decreased over time (1 month mean = 1.51; 12 month mean = 1.26) and resembled the trajectories of PTSD symptoms and functional limitations. CONCLUSIONS. The concerns of physically injured trauma survivors are readily elicited and followed up during the course of the year after injury. Open-ended inquiry regarding post-traumatic concerns may complement standardized outcome assessments by identifying and contextualizing the outcomes of greatest importance to patients.

AB - BACKGROUND. Approximately 2.5 million Americans are admitted to the hospital after traumatic physical injury each year. Few investigations have elicited patients' perspectives regarding posttraumatic outcomes. OBJECTIVE. To identify and categorize physically injured trauma survivors' posttraumatic concerns. RESEARCH DESIGN. Prospective longitudinal investigation; trauma survivors were interviewed during the post-injury hospitalization and again 1, 4, and 12 months after the trauma. SUBJECTS. Ninety-seven, randomly selected, English speaking, hospitalized survivors of motor vehicle-crashes or assaults. MEASURES. At the end of each interview patients were asked, "Of all the things that have happened to you since you were injured, what concerns you the most?" Using an iterative process and working by consensus, investigators categorized patient concerns in content domains. Concern domains were then compared with established measures of posttraumatic stress disorder (PTSD) symptoms and limitations in physical functioning. RESULTS. Seven categories of posttraumatic concerns were identified. During the course of the year, 73% of patients expressed physical health concerns, 58% psychological concerns, 53% work and finance concerns, 40% social concerns, 10% legal concerns, 10% medical concerns, and 20% uncodable concerns. Rater agreement on concern categorization was substantial (κ = 0.72). The mean number of concerns expressed per patient gradually decreased over time (1 month mean = 1.51; 12 month mean = 1.26) and resembled the trajectories of PTSD symptoms and functional limitations. CONCLUSIONS. The concerns of physically injured trauma survivors are readily elicited and followed up during the course of the year after injury. Open-ended inquiry regarding post-traumatic concerns may complement standardized outcome assessments by identifying and contextualizing the outcomes of greatest importance to patients.

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