According to a research letter published in the February 11 online issue of JAMA Internal Medicine reporting the findings of a study by Donald Edmondson, Ph.D., and colleagues at Columbia University Medical Center, New York, emergency department (ED) crowding may be associated with acute coronary syndrome (ACS)-induced post-traumatic stress disorder (PTSD) symptoms. 

The symptoms are a risk factor for ACS recurrence and mortality, and a known contributor to poor quality of life, patient satisfaction and increased medical utilization, according to the study.

Researchers recorded the time of presentation to the ED of a large New York City teaching hospital for 135 patients in the ongoing Prescription Use, Lifestyle, Stress Evaluation (PULSE) study between 2009 and 2011. The length of stay in the ED was more than 11 hours for the patients whose average age was 63 years. After adjusting for a number of factors including ACS severity, medical comorbidities, demographic factors, and depression, increasing amounts of ED crowding were associated with higher ACS-induced PTSD symptoms at one month.

"A mechanism for the association of ED crowding to increased PTSD symptoms may be that a more chaotic environment may foster or inflate perceptions of increased life threat and decreased control, which may in turn contribute to greater acute psychological and physiological arousal," the study concludes. "Although our results are based on a small sample from a single ED, we believe they suggest the need for greater awareness of the influence of medical environments on patients' psychological wellbeing, while underscoring the need for hospital administrators and policymakers to address ED overcrowding."

This study was supported by grants from the National Center for Advancing Translational Sciences-National Center for Research Resources/National Institutes of Health, Bethesda, Maryland, USA.