Glasgow Coma Scores, Early Opioids, and Posttraumatic Stress Disorder Among Combat Amputees

Authors


  • This study and the manuscript itself benefited greatly from advice and assistance from the clinicians, epidemiologists, technical writers, database analysts, and programmers working on the Expeditionary Medical Encounter Database Project at the Naval Health Research Center, including Carrie Brown, Mary Clouser, Judy Dye, Natella Feinstein, Peggy Han, Troy Holbrook, Charles Jackson, Hoa Ly, Andrew MacGregor, and Gerry Pang.

  • This project was funded by the Navy Bureau of Medicine and Surgery Wounded, Ill, and Injured program, under work unit no. 61108. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. Approved for public release; distribution is unlimited. This research was conducted in compliance with all applicable federal regulations governing the protection of human participants (NHRC IRB protocol 2007.0016).

Abstract

A recent study found that combat amputees had a reduced prevalence of posttraumatic stress disorder (PTSD) compared with nonamputees with serious extremity injuries. We hypothesized that an extended period of impaired consciousness or early treatment with morphine could prevent consolidation of traumatic memory and the development of PTSD. To examine this hypothesis, we retrospectively reviewed 258 combat casualty records from the Iraq or Afghanistan conflicts from 2001–2008 in the Expeditionary Medical Encounter Database, including medications and Glasgow Coma Scale (GCS) scores recorded at in-theater facilities within hours of the index injury. All patients sustained amputations from injuries. Psychological diagnoses were extracted from medical records for 24 months postinjury. None of 20 patients (0%) with GCS scores of 12 or lower had PTSD compared to 20% of patients with GCS scores of 12 or greater who did have PTSD. For patients with traumatic brain injury, those treated with intravenous morphine within hours of injury had a significantly lower prevalence of PTSD (6.3%) and mood disorders (15.6%) compared to patients treated with fentanyl only (prevalence of PTSD = 41.2%, prevalence of mood disorder = 47.1%). GCS scores and morphine and fentanyl treatments were not significantly associated with adjustment, anxiety, or substance abuse disorders.

Traditional and Simplified Chinese Abstracts by AsianSTSS

標題:戰鬥中截肢生還者的格拉斯哥昏迷評分,早期鴉片類藥物使用和創傷後壓力症

撮要:近日研究指出戰鬥中截肢生還者對比其他嚴重肢體受創但無截肢者有較低創傷後壓力症(PTSD)患病率。我們假設較長神志不清時間或早期嗎啡治療能避免創傷記憶鞏固和PTSD形成。我們追溯覆審258個伊拉克或阿富汗戰鬥傷亡紀錄來驗證假設,包括2001至2008年遠征行動醫療數據庫中藥物和格拉斯哥昏迷評分(GCS)(是受傷事件數小時內手術室中記下)。所有病人受傷後需截肢,而受傷後24個月內醫療紀錄中抽取其心理學診斷,但GCS 12分或以下者(共20名病人)全部沒有PTSD(0%),而GCS 12分或以上者有20%有PTSD。創傷性腦受創者在受傷後數小時內接受靜脈嗎啡注射對比只接受芬太尼者 (PTSD患病率=41.2%,情緒病患病率=47.1%),則有統計學上顯著較低PTSD患病率(6.3%)和情緒病患病率(15.6%)。GCS評分,嗎啡和芬太尼治療未有顯著地與適應,焦慮或物質濫用有關連。

标题:战斗中截肢生还者的格拉斯哥昏迷评分,早期鸦片类药物使用和创伤后压力症

撮要:近日研究指出战斗中截肢生还者对比其他严重肢体受创但无截肢者有较低创伤后压力症(PTSD)患病率。我们假设较长神志不清时间或早期吗啡治疗能避免创伤记忆巩固和PTSD形成。我们追溯覆审258个伊拉克或阿富汗战斗伤亡纪录来验证假设,包括2001至2008年远征行动医疗数据库中药物和格拉斯哥昏迷评分(GCS)(是受伤事件数小时内手术室中记下)。所有病人受伤后需截肢,而受伤后24个月内医疗纪录中抽取其心理学诊断,但GCS 12分或以下者(共20名病人)全部没有PTSD(0%),而GCS 12分或以上者有20%有PTSD。创伤性脑受创者在受伤后数小时内接受静脉吗啡注射对比只接受芬太尼者 (PTSD患病率=41.2%,情绪病患病率=47.1%),则有统计学上显著较低PTSD患病率(6.3%)和情绪病患病率(15.6%)。GCS评分,吗啡和芬太尼治疗未有显著地与适应,焦虑或物质滥用有关连。

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