Sat., 10/10/09 Basic Sci./Injury Prevent./Spine, Paper #74, 11:30 am OTA-2009
A Prospective Study of Cognitive Deficits, Depression and Posttraumatic Stress Disorder (PTSD) in Trauma Patients without Intracranial Injury
William T. Obremskey, MD, MPH (5A-Medtronic, Osteogenix; 7-Synthes);
Rebecca Bauer, MD, MPH (n); Christine Abraham (n); Venice Anderson, MA (n);
Yanna Song, MA (n); Kristin Archer, PhD, DPT (n);
Oscar Guillamondegui, MD (n); James C. Jackson, PsyD (n);
E. Wesley Ely, MD, MPH (7-Synthes)
Vanderbilt University Medical Center, Nashville, Tennessee, USA
Purpose: We undertook this study to determine the prevalence of persistent cognitive impairment and emotional and functional difficulties 12 months after injury and the risk factors for persistent cognitive impairment in a sample of moderate and severely injured adult trauma ICU survivors without intracranial hemorrhage.
Methods: We prospectively enrolled 174 patients from the Vanderbilt University Trauma ICU admitted from July 2006 to June 2007 with an ISS >16 and a head CT scan showing no intracranial hemorrhage. 109 (71% follow-up of living eligible patients) were evaluated in person 12 to 24 months after hospital discharge, with a comprehensive battery of cognitive, emotional, and functional instruments. The Informant Questionnaire of Cognitive Decline in the Elderly-Short Form (IQCODE-SF) was used to evaluate for preexisting cognitive deficits in patients suspected of having cognitive impairment before their trauma.
Results: A total of 58 patients (53%) were determined to have cognitive impairment, which was most pronounced in the domains of attention and executive functioning/verbal fluency. Of these patients, 5 (5%) were determined by the IQCODE-SF (based on mean score ≥3.31) to be cognitively impaired before trauma ICU hospitalization. Patients reported significant depressive symptoms (41%) and significant symptoms of posttraumatic stress disorder (26%). Quality of life scores were lower than in the general U.S. population and employment difficulties were widespread. A total of 40.24% of patients reported being unemployed at follow-up.
Conclusions: The majority (53%) of trauma survivors without intracranial hemorrhage display persistent cognitive impairment. This cognitive impairment was associated with functional defects and poor quality of life. A large percentage of trauma patients also have symptoms of depression (41%) and posttraumatic stress disorder (26%). Orthopaedic trauma surgeons frequently follow these patients over an extended period of time and may need to recognize these issues to refer patients to appropriate neuropsychological testing, counseling, or therapy.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant