Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors

Dimitry S. Davydow, Douglas F. Zatzick, Frederick P. Rivara, Gregory J. Jurkovich, Jin Wang, Peter P. Roy-Byrne, Wayne J. Katon, Catherine L. Hough, Erin K. Kross, Ming Yu Fan, Jutta Joesch, Ellen J Mackenzie

Research output: Contribution to journalArticle

Abstract

Objective: To assess intensive care unit (ICU)/acute care service-delivery characteristics and pre-ICU factors as predictors of posttraumatic stress disorder (PTSD) and return to usual major activity after ICU admission for trauma. Method: Data from the National Study on the Costs and Outcomes of Trauma were used to evaluate a prospective cohort of 1906 ICU survivors. We assessed PTSD with the PTSD Checklist. Regression analyses ascertained associations between ICU/acute care service-delivery characteristics, pre-ICU factors, early post-ICU distress and 12-month PTSD and return to usual activity, while controlling for clinical and demographic characteristics. Results: Approximately 25% of ICU survivors had symptoms suggestive of PTSD. Increased early post-ICU distress predicted both PTSD and diminished usual major activity. Pulmonary artery catheter insertion [risk ratio (RR) 1.28, 95% confidence interval (95% CI) 1.05-1.57, P=.01] and pre-ICU depression (RR 1.23, 95% CI 1.02-1.49, P=.03) were associated with PTSD. Longer ICU lengths of stay (RR 1.21, 95% CI 1.03-1.44, P=.02) and tracheostomy (RR 1.29, 95% CI 1.05-1.59, P=.01) were associated with diminished usual activity. Greater preexisting medical comorbidities were associated with PTSD and limited return to usual activity. Conclusions: Easily identifiable risk factors including ICU/acute care service-delivery characteristics and early post-ICU distress were associated with increased risk of PTSD and limitations in return to usual major activity. Future investigations could develop early screening interventions in acute care settings targeting these risk factors, facilitating appropriate treatments.

Original languageEnglish (US)
Pages (from-to)428-435
Number of pages8
JournalGeneral Hospital Psychiatry
Volume31
Issue number5
DOIs
StatePublished - Sep 2009

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Post-Traumatic Stress Disorders
Intensive Care Units
Survivors
Odds Ratio
Confidence Intervals
Tracheostomy
Wounds and Injuries
Checklist
Pulmonary Artery
Comorbidity
Length of Stay
Catheters
Regression Analysis
Demography
Depression

Keywords

  • Critical care
  • Intensive care unit
  • Outcome assessment (health care)
  • Risk factors
  • Stress disorder, Posttraumatic

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors. / Davydow, Dimitry S.; Zatzick, Douglas F.; Rivara, Frederick P.; Jurkovich, Gregory J.; Wang, Jin; Roy-Byrne, Peter P.; Katon, Wayne J.; Hough, Catherine L.; Kross, Erin K.; Fan, Ming Yu; Joesch, Jutta; Mackenzie, Ellen J.

In: General Hospital Psychiatry, Vol. 31, No. 5, 09.2009, p. 428-435.

Research output: Contribution to journalArticle

Davydow, DS, Zatzick, DF, Rivara, FP, Jurkovich, GJ, Wang, J, Roy-Byrne, PP, Katon, WJ, Hough, CL, Kross, EK, Fan, MY, Joesch, J & Mackenzie, EJ 2009, 'Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors', General Hospital Psychiatry, vol. 31, no. 5, pp. 428-435. https://doi.org/10.1016/j.genhosppsych.2009.05.007
Davydow, Dimitry S. ; Zatzick, Douglas F. ; Rivara, Frederick P. ; Jurkovich, Gregory J. ; Wang, Jin ; Roy-Byrne, Peter P. ; Katon, Wayne J. ; Hough, Catherine L. ; Kross, Erin K. ; Fan, Ming Yu ; Joesch, Jutta ; Mackenzie, Ellen J. / Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors. In: General Hospital Psychiatry. 2009 ; Vol. 31, No. 5. pp. 428-435.
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AU - Davydow, Dimitry S.

AU - Zatzick, Douglas F.

AU - Rivara, Frederick P.

AU - Jurkovich, Gregory J.

AU - Wang, Jin

AU - Roy-Byrne, Peter P.

AU - Katon, Wayne J.

AU - Hough, Catherine L.

AU - Kross, Erin K.

AU - Fan, Ming Yu

AU - Joesch, Jutta

AU - Mackenzie, Ellen J

PY - 2009/9

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N2 - Objective: To assess intensive care unit (ICU)/acute care service-delivery characteristics and pre-ICU factors as predictors of posttraumatic stress disorder (PTSD) and return to usual major activity after ICU admission for trauma. Method: Data from the National Study on the Costs and Outcomes of Trauma were used to evaluate a prospective cohort of 1906 ICU survivors. We assessed PTSD with the PTSD Checklist. Regression analyses ascertained associations between ICU/acute care service-delivery characteristics, pre-ICU factors, early post-ICU distress and 12-month PTSD and return to usual activity, while controlling for clinical and demographic characteristics. Results: Approximately 25% of ICU survivors had symptoms suggestive of PTSD. Increased early post-ICU distress predicted both PTSD and diminished usual major activity. Pulmonary artery catheter insertion [risk ratio (RR) 1.28, 95% confidence interval (95% CI) 1.05-1.57, P=.01] and pre-ICU depression (RR 1.23, 95% CI 1.02-1.49, P=.03) were associated with PTSD. Longer ICU lengths of stay (RR 1.21, 95% CI 1.03-1.44, P=.02) and tracheostomy (RR 1.29, 95% CI 1.05-1.59, P=.01) were associated with diminished usual activity. Greater preexisting medical comorbidities were associated with PTSD and limited return to usual activity. Conclusions: Easily identifiable risk factors including ICU/acute care service-delivery characteristics and early post-ICU distress were associated with increased risk of PTSD and limitations in return to usual major activity. Future investigations could develop early screening interventions in acute care settings targeting these risk factors, facilitating appropriate treatments.

AB - Objective: To assess intensive care unit (ICU)/acute care service-delivery characteristics and pre-ICU factors as predictors of posttraumatic stress disorder (PTSD) and return to usual major activity after ICU admission for trauma. Method: Data from the National Study on the Costs and Outcomes of Trauma were used to evaluate a prospective cohort of 1906 ICU survivors. We assessed PTSD with the PTSD Checklist. Regression analyses ascertained associations between ICU/acute care service-delivery characteristics, pre-ICU factors, early post-ICU distress and 12-month PTSD and return to usual activity, while controlling for clinical and demographic characteristics. Results: Approximately 25% of ICU survivors had symptoms suggestive of PTSD. Increased early post-ICU distress predicted both PTSD and diminished usual major activity. Pulmonary artery catheter insertion [risk ratio (RR) 1.28, 95% confidence interval (95% CI) 1.05-1.57, P=.01] and pre-ICU depression (RR 1.23, 95% CI 1.02-1.49, P=.03) were associated with PTSD. Longer ICU lengths of stay (RR 1.21, 95% CI 1.03-1.44, P=.02) and tracheostomy (RR 1.29, 95% CI 1.05-1.59, P=.01) were associated with diminished usual activity. Greater preexisting medical comorbidities were associated with PTSD and limited return to usual activity. Conclusions: Easily identifiable risk factors including ICU/acute care service-delivery characteristics and early post-ICU distress were associated with increased risk of PTSD and limitations in return to usual major activity. Future investigations could develop early screening interventions in acute care settings targeting these risk factors, facilitating appropriate treatments.

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