Brief Intervention Can Prompt Lasting PTSD Relief in Injured Patients

By David Douglas

March 22, 2021

NEW YORK (Reuters Health) - Focused exposure using an integrated stepped approach by trauma center clinicians can lead to a significant reduction in posttraumatic stress disorder (PTSD) symptoms in injured patients, according to a randomized clinical trial.

As Dr. Douglas Zatzick told Reuters Health by email, "when well implemented, a brief (approximately 2 hour) collaborative-care intervention delivered by front-line trauma-center providers can significantly reduce posttraumatic stress disorder symptoms in diverse injury survivors, including survivors of firearm injuries. Collaborative care may therefore be an optimal treatment approach for patients treated in acute-care medical settings."

In a paper in JAMA Surgery, Dr. Zatzick, of the University of Washington School of Medicine, in Seattle, and colleagues note that such strategies "that combine proactive case management, pharmacotherapy targeting PTSD, and behavioral intervention elements embedded within injury care management have demonstrated effectiveness in reducing PTSD symptoms while also broadening intervention reach."

To help further assess the efficacy of this approach, the researchers used a stepped wedge protocol to evaluate hospitalized survivors of physical injury at 25 U.S. level-I trauma centers.

All had undergone a two-step evaluation for PTSD symptoms and of those reporting high levels of distress on the PTSD Checklist (PCL-C), 370 patients joined the control phase and 265 did so for the intervention phase.

The intervention, explain the researchers, "included proactive injury case management that assisted patients transitioning from hospital inpatient to outpatient and community settings. The intervention also integrated evidence-based pharmacotherapy and psychotherapeutic elements targeting PTSD symptoms and comorbidity."

Follow-up was for a total of 12 months with approximately 75% of patients still participating at that point. Site intervention teams spent a mean of 122 minutes with each patient over the course of the year after injury. Most interventions took place within three months.

There was a statistically significant drop in PCL-C scores for intervention patients compared with controls at six months, but the difference was no longer significant at 12 months.

"Greater baseline PTSD risk and good or excellent trauma center protocol implementation were associated with larger PTSD treatment effects," the authors note.

In an accompanying editorial, Drs. Adil Haider and Hamna Shahbaz of Aga Khan University, in Karachi, Pakistan, note, "The results from this study offer a unique opportunity for policy makers to carry out concentrated efforts to develop multidisciplinary programs that can ultimately inform the care of trauma patients and could also be generalizable in other settings."

SOURCE: https://bit.ly/3vH5Avs and https://bit.ly/3tybxJ1 JAMA Surgery, online March 10, 2021.

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