Pain, Depression, and Posttraumatic Stress Disorder Following Major Extremity Trauma Among United States Military Serving in Iraq and Afghanistan: Results From the Military Extremity Trauma and Amputation/Limb Salvage Study.

Autor:	Castillo RC; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Carlini AR; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Doukas WC; UHC Orthopedics, Bridgeport, WV., Hayda RA; Rhode Island Hospital, Brown University, Providence, RI., Frisch HM; Orthopaedic Trauma Service, Mission Hospital, Asheville, NC., Andersen RC; Walter Reed National Military Medical Center, Bethesda, MD.; Riverside Health System, Newport News, VA., D'Alleyrand JC; Walter Reed National Military Medical Center, Bethesda, MD.; Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; and., Mazurek MT; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.; UHC Orthopedics, Bridgeport, WV.; Rhode Island Hospital, Brown University, Providence, RI.; Orthopaedic Trauma Service, Mission Hospital, Asheville, NC.; Walter Reed National Military Medical Center, Bethesda, MD.; Riverside Health System, Newport News, VA.; Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; and.; Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX., Ficke JR; Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX., Keeling JJ; Walter Reed National Military Medical Center, Bethesda, MD., Pasquina PF; Walter Reed National Military Medical Center, Bethesda, MD., Wain HJ; Walter Reed National Military Medical Center, Bethesda, MD., MacKenzie EJ; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Jazyk:	angličtina
Zdroj:	Journal of orthopaedic trauma [J Orthop Trauma] 2021 Mar 01; Vol. 35 (3), pp. e96-e102.
DOI:	10.1097/BOT.0000000000001921
Abstrakt:	Objectives: Assess the burden and co-occurrence of pain, depression, and posttraumatic stress disorder (PTSD) among service members who sustained a major limb injury, and examine whether these conditions are associated with functional outcomes. Design: A retrospective cohort study. Setting: Four U.S. military treatment facilities: Walter Reed Army Medical Center, National Naval Medical Center, Brooke Army Medical Center, and Naval Medical Center San Diego. Patients/participants: Four hundred twenty-nine United States service members who sustained a major limb injury while serving in Afghanistan or Iraq met eligibility criteria upon review of their medical records. Intervention: Not applicable. Main Outcome Measurements: Outcomes assessed were: function using the short musculoskeletal functional assessment; PTSD using the PTSD Checklist and diagnostic and statistical manual criteria; pain using the chronic pain grade scale. Results: Military extremity trauma and amputation/limb salvage patients without pain, depression, or PTSD, were, on average, about one minimally clinically important difference (MCID) from age- and gender-adjusted population norms. In contrast, patients with low levels of pain and no depression or PTSD were, on average, one to 2 MCIDs from population norms. Military extremity trauma and amputation/limb salvage patients with either greater levels of pain, and who experience PTSD, depression, or both, were 4 to 6 MCIDs from population norms. Regression analyses adjusting for injury type (upper or lower limb, salvage or amputation, and unilateral or bilateral), age, time to interview, military rank, presence of a major upper limb injury, social support, presence of mild traumatic brain injury/concussion, and combat experiences showed that higher levels of pain, depression, and PTSD were associated with lower one-year functional outcomes. Conclusions: Major limb trauma sustained in the military results in significant long-term pain and PTSD. Overall, the results are consistent with the hypothesis that pain, depression, and PTSD are associated with disability in this population. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Competing Interests: The authors report no conflict of interest. (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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