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Posttraumatic Stress, Problem Drinking, and Functional Outcomes After Injury
Douglas F. Zatzick, MD;
Gregory J. Jurkovich, MD;
Larry Gentilello, MD;
David Wisner, MD;
Fredrick P. Rivara, MD, MPH
Arch Surg. 2002;137:200-205.
Hypothesis Patients undergoing trauma surgery for injury who have subsequent posttraumatic stress disorder (PTSD) or problem drinking will demonstrate significant impairments in functional outcomes compared with patients without these disorders.
Design Prospective cohort study.
Setting Level I academic trauma center.
Participants One hundred one randomly selected survivors of intentional and unintentional injuries were interviewed while hospitalized and again 1 year later. The investigation achieved a 73% 1-year follow-up rate.
Main Outcome Measures Posttraumatic stress disorder was assessed with the Post-traumatic Stress Disorder Checklist and problem drinking was assessed with the Alcohol Use Disorder Identification Test. Functional status was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey.
Results One year after injury, 30% of patients (n = 22) met symptomatic criteria for PTSD and 25% (n = 18) had Alcohol Use Disorder Identification Test scores indicative of problem drinking. Patients with PTSD demonstrated significant adverse outcomes in 7 of the 8 domains of the Medical Outcomes Study 36-Item Short-Form Health Survey compared with patients without PTSD. In multivariate models that adjusted for injury severity, chronic medical conditions, age, sex, preinjury physical function, and alcohol use, PTSD remained the strongest predictor of an adverse outcome. Patients with problem drinking did not demonstrate clinically or statistically significant functional impairment compared with patients without problem drinking.
Conclusions Posttraumatic stress disorder persisted in 30% of patients 1 year after traumatic injury and was independently associated with a broad profile of functional impairment. The development of treatment intervention protocols for trauma patients with PTSD is warranted.
From the Harborview Injury Prevention and Research Center (Drs Zatzick, Jurkovich, Gentilello, and Rivara) and Departments of Psychiatry (Dr Zatzick), Surgery (Drs Jurkovich and Gentilello), and Pediatrics (Dr Rivara), University of Washington School of Medicine, Seattle; and the Department of Surgery, University of California–Davis Medical Center, Sacramento (Dr Wisner).
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