"Any illness or psychological disturbance
that has a substantial negative impact on outcome after trauma cannot
be ignored. In some cases, post-traumatic psychological illness
may have a stronger effect on outcome than the severity of the injury
itself," said Adam J. Starr, M.D., principal investigator of
the American study.
The current study was developed because serious
extremity injury was known to have a highly negative impact on quality
of life, but no research had been done to assess prevalence of post-traumatic
stress disorder in orthopedic patients. The questionnaire used in
the study was the Revised Civilian Mississippi Scale for Post-Traumatic
Stress Disorder, a self-report questionnaire that is widely used
by American mental-health professionals and is based on diagnostic
criteria for the disorder. The investigative team created one additional
question asking whether emotional aspects caused by the injury were
more difficult to cope with than the physical problems.
Researchers evaluated 330 trauma follow-up
patients with various injury histories, including motor vehicle
collision, vehicle-pedestrian collision, motorcycle collision, crush
injuries, horseback riding injuries, and gunshot wounds. The average
injury severity score was 8.3 on a scale with a range of 1 to 36.
The average time elapsed since injury was14 months.
The research team found that 52 percent of the orthopedic trauma
patients who answered the questionnaire met the diagnostic criteria
for the disorder. These patients also had significantly higher injury
severity scores. Another trend was that increased elapsed time since
injury was associated with increased risk for post-traumatic stress
disorder rather than with gradually decreasing risk.