Surgery News - June 2008 - (Page 2)

NEWS SURGERY NEWS • J U N E 2 0 0 8 Routine Screening Recommended PTSD • from page 1 Rate of Not Returning to Work 1 Year After Traumatic Injury 78% 67% injuries, an exclusion criterion. One year post injury, 20.7% of subjects met diagnostic criteria for PTSD using the validated 17item PTSD checklist. Another 6.6% met criteria for depression using the Center for Epidemiologic Studies Depression Scale, and 4.9% had both psychiatric disorders. After 1 year, 45% of patients employed preinjury had not returned to work. The rate varied significantly depending upon whether a patient had neither psychiatric disorder, one, or both (see box). In a multivariate analysis adjusting for injury severity, pre- morbid psychiatric disorders, and preinjury health status and functioning, having either PTSD or depression was an independent risk factor associated with a 3.2fold greater likelihood of failure to return to work than for those with neither disorder. Patients with both depression and PTSD were at a 5.6-fold increased risk. A similar stepwise relationship was observed between the number of psychiatric diagnoses present and other measures of functional impairment collected in the study, including return to usual activities as well as physical and mental health status as assessed using the Short Form 36, Dr. Zatzick continued. The prevalence of PTSD and depression was similar in patients treated at level 1 trauma centers and those treated at community hospitals. So were adjusted return-to-work rates. “As a trauma community, we are largely ignoring this problem currently,” said Dr. See current and archived issues of David B. Hoyt, an ACS Fellow who is professor of surgery and chief online at www.facs.org. of the division of trauma, burns, and critical And don't miss the exclusive care at the University online-only articles of California, San available on the Web site. Diego. “It’s hard to get psyMore news is just a click away! chiatric consults for in- patient trauma patients,” he said, pondering the daunting prospect of screening 2.5 million patients per year. “Will the psychiatric community step up to help? Who will be available to help manage this complicated problem?” Col. John B. Holcomb, MC, USA, commented that the prevalence of PTSD and depression documented in NSCOT is “exactly the same” as what he and others have found in both military and civilian trauma populations. “Just screen everybody. I don’t think PTSD is related to your family or work status. And we find it’s not related to severity of injury; what we would consider a minor injury the patient may consider a major injury,” said Dr. Holcomb, an ACS Fellow and commander of the U.S. Army Institute of Surgical Research, Brooke Army Medical Center, San Antonio. NSCOT copresenter Dr. Gregory J. Jurkovich said the nation’s major trauma centers must bear most of the responsibility for screening for psychiatric morbidity in injured patients. “They have really become the linchpin of managing trauma patients, much more so than community hospitals, and that will become even more true as regionalization of trauma care continues. But with that status as the centerpiece of care comes the responsibility for broad-based care involving collaborative effort between psychiatrists, psychologists, 39% ELSEVIER GLOBAL MEDICAL NEWS Neither PTSD nor depression Either PTSD or depression Both PTSD and depression Note: Based on data for 2,707 patients hospitalized for injuries requiring surgery. PTSD is posttraumatic stress disorder. Source: Dr. Zatzick rehabilitation specialists, and others,” said Dr. Jurkovich, an ACS Fellow who is professor of surgery at the University of Washington and chief of trauma services at Harborview Medical Center, both in Seattle. What should one look for when screening for PTSD? The disorder can’t be formally diagnosed until at least 1 month after the traumatic event. But the strongest predictor of subsequent PTSD is development of an acute stress disorder during the hospitalization. This acute stress response is marked by the same three classes of symptoms that define PTSD: intrusive symptoms such as flashbacks and nightmares, avoidance behavior, and hyperarousal as evidenced by insomnia, inability to concentrate, and an exaggerated startle response. Other indicators of increased likelihood of PTSD occurring in trauma patients include a history of more than four prior hospitalizations for trauma, female gender, and a positive urine toxicology screen, Dr. Jurkovich said. Prevention and treatment of PTSD are “somewhat problematic” and warrant far more research, he noted. One theory holds that the disorder results from imprinting of the trauma in patients with elevated catecholamines at the time of injury. Consistent with this theory is the finding that trauma patients who are more tachycardic are at increased risk for later PTSD. But prophylactic β-blocker therapy has proved ineffective. Moreover, the use of SSRIs in patients with PTSD has been disappointing. The best treatment at present is cognitive-behavioral therapy, he concluded. SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director of Communications Linn Meyer EDITORIAL ADVISORY BOARD Anesthesiology: Robert Morell, M.D., Clinical Associate Professor of Anesthesia, Fort Walton Beach Medical Center Bariatric: Myriam J. Curet, M.D., FACS, Professor of Surgery, Stanford University Cardiothoracic: Mark S. Allen, M.D., FACS, Professor of Surgery, Mayo Clinic Cardiothoracic: Fred A. Crawford, Jr., M.D., FACS, Chief, Division of Cardiothoracic Surgery, Medical University of South Carolina Colorectal: Robert Madoff, M.D., FACS, Professor of Surgery, University of Minnesota Endocrine Surgery: Robert Udelsman M.D., FACS, Chairman, Department of Surgery, Yale University Ethics: James W. Jones, M.D., Ph.D., FACS, Visiting Professor of Medicine and Medical Ethics, Baylor University Information Technology: Patricia L. Turner, M.D., FACS, Assistant Professor of Surgery, University of Maryland Minimally Invasive and Gastrointestinal: Gerald M. Fried, M.D., FACS, Professor of Surgery, McGill University Neurological: Hunt Batjer, M.D., FACS, Michael J. Marchese Professor, Northwestern University Obstetrics and Gynecology: William J. Hoskins, M.D., FACS, Executive Director of Surgical Activities, Memorial Sloan-Kettering Cancer Center Ophthalmology: Natalie C. Kerr, M.D., FACS, Chief, Pediatric Ophthalmology Service, University of Tennessee Orthopedic: Mark R. Belsky, M.D., FACS, Chief of Orthopedic Surgery, Newton-Wellesley Hospital Otolaryngology: Mark Weissler, M.D., FACS, J.P. Riddle Distinguished Professor, University of North Carolina Pediatric Surgery: Thomas F. Tracy, Jr., M.D., FACS, Pediatric Surgeon-in-Chief, Hasbro Children's Hospital Plastic Surgery: Linda Phillips, M.D., FACS, Truman G. Blocker Jr., M.D. Distinguished Professor, University of Texas Resident/Associate Society: Ted A. James, M.D., Assistant Professor of Surgery, University of Vermont Surgical Oncology: James P. Neifeld, M.D., FACS, Chairman, Department of Surgery, Virginia Commonwealth University Transplantation: Jeffrey Punch, M.D., FACS, Associate Professor of Surgery, University of Michigan Trauma (Burns and Mass Casualties): Steven E. Wolf, M.D., FACS, Professor of Surgery, University of Texas Trauma and Critical Care: Grace S. Rozycki, M.D., FACS, Professor of Surgery, Emory University Urology: Badrinath R. Konety, M.D., FACS, Vice Chair, Dept. of Urology, University of California at San Francisco Vascular: Linda Harris, M.D., FACS, Associate Professor of Surgery, Millard Fillmore Hospital SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. Content for the NEWS FROM THE COLLEGE is provided by the American College of Surgeons. The ideas and opinions expressed in SURGERY NEWS do not necessarily reflect those of the College or the Publisher. The American College of Surgeons and Elsevier Society News Group, a division of Elsevier Inc., will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. POSTMASTER: Send changes of address (with old mailing label) to Circulation, SURGERY NEWS, 60 B Columbia Rd., 2nd flr., Morristown, NJ 07960. The American College of Surgeons’ headquarters is located at 633 N. Saint Clair St., Chicago, IL 60611-3211. SURGERY NEWS (ISSN 1553-6785) is published monthly for the American College of Surgeons by Elsevier Inc., 60 B Columbia Rd., 2nd flr., Morristown, NJ 07960; 973-290-8200; fax 973-290-8250. ELSEVIER SOCIETY NEWS GROUP, A DIVISION OF INTERNATIONAL MEDICAL NEWS GROUP President, IMNG Alan J. Imhoff Director, ESNG Mark Branca Executive Director, Editorial Mary Jo M. 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Surgery News - June 2008

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