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Trauma centers should routinely screen trauma victims for mental health problems and alcohol abuse or dependence

More than half of trauma center patients suffer from high early levels of posttraumatic stress or alcohol abuse/dependence. Indeed, many are intoxicated with alcohol or stimulants at the time of their acute care admission, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11372). Early mental health screening and intervention procedures that target both posttraumatic stress disorder (PTSD) and alcohol use should be developed for acute care settings, suggests Douglas Zatzick, M.D., of the University of Washington School of Medicine.

Dr. Zatzick and his colleagues screened 269 randomly selected injury survivors (aged 14 years and older) hospitalized at two trauma centers for PTSD (typically characterized by symptoms such as intrusive thoughts or nightmares, emotional numbing, avoidance of trauma reminders, irritability, and insomnia), depression, and peritraumatic dissociative symptoms (for example, feelings that the event was unreal or amnesia for all or part of the event). The researchers conducted 1-hour face-to-face interviews with injured surgical inpatients to obtain demographic information and assess early posttraumatic distress, alcohol use, and prior trauma.

Overall, 58 percent of the trauma patients demonstrated high levels of immediate posttraumatic distress or alcohol abuse/dependence. Also, 45 percent of the patients showed high levels of immediate distress in the surgical ward, and 26 percent were diagnosed with alcohol abuse/dependence. Across both sites, 20 percent of the trauma victims had high levels of PTSD symptoms, 36 percent had high levels of depressive symptoms, and 20 percent met symptomatic criteria for acute stress disorder (ASD). More than 60 percent of patients at one site and 36 percent of patients at the other site reported experiencing four or more serious traumas before the event that brought them to the hospital. Greater prior trauma, female sex, minority race, and treatment site independently predicted high levels of distress.

See "Posttraumatic distress, alcohol disorders, and recurrent trauma across level 1 trauma centers," by Dr. Zatzick, Gregory Jurkovich, M.D., Joan Russo, Ph.D., and others, in the August 2004 Journal of Trauma 57, pp. 360-366.

Editor's note: Another AHRQ-supported study of emergency care shows that the physician-patient encounter during care in the emergency department is typically brief and lacking in important health information. The authors call for more provider education and significant system support to improve emergency department communication. For more details, see Rhodes, K.V., Vieth, T., He, T., and others (2004, September). "Resuscitating the physician-patient relationship: Emergency department communication in an academic medical center." (AHRQ grant HS11096). Annals of Emergency Medicine 44, pp. 262-267.

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