Session III - Polytrauma
The Incidence of Mental Distress in Orthopaedic Trauma Patients
Background: Patients involved in trauma may experience mental distress because of the accident itself or because of financial and personal hardships caused by that trauma. Although the incidence of posttraumatic stress disorder has been reported, the fact remains that orthopaedic surgeons do not typically recognize mental distress in the clinical setting nor do they have the training to treat it.
Methods: All patients who visit the orthopaedic trauma clinic for follow-up are given an SF-36 each time they come in. These SF-36s are entered into a computer database. These SF-36 scores were examined retrospectively to determine the incidence of mental distress (MCS <42) in our population. We then examined our electronic medical record to identify all patients who were identified as having depression based on clinical findings. There were 15,298 SF-36 scores in the database, which represents 5,468 patients. Of these, 1,017 had more than 4 SF-36 observations. This group served as the basis of this study.
Results: Of the 1,017 patients included in the study, 780 (76.7%) experienced at least one score with a Mental Component Scale (MCS) of <42. There was no difference between male and female patients in the incidence of mental distress. However, only 46 (5.9%) of these patients were identified by the orthopaedic surgeon or primary care team as having depression or another mental disorder. These 46 patients were started on an antidepressant by the orthopaedic surgeon. Of this group, posttreatment follow-up SF-36 scores were available for only 13 patients. There was no statistical difference between pre- and posttreatment SF-36 scores for these patients.
Conclusions: Mental distress is extremely common in patients who have sustained orthopaedic trauma. However, the orthopaedic surgeon, even when aware of this, is very poor at identifying these patients. Furthermore, treatment initiated by the surgeon without psychiatric follow-up is not successful. Further study is needed to develop a rapid screening tool to allow orthopaedic surgeons, who often fill the role of a primary care physician in the trauma population, to identify patients who may benefit from psychiatric help. Also, surgeons should be aware of the likelihood of mental distress in this population and should develop referral pathways to professional psychiatric resources.