Early psychological reactions to life-threatening injuries

Objective: To assess the prevalence of posttraumatic stress symptoms and co ping patterns in severely injured accident victims; to study correlations b etween injury severity and psychosocial variables and the presence of postt raumatic stress symptoms; and to analyze intensive care unit (ICU) personne l's global clinical appraisals in relation to patient characteristics. Design: A study of critically ill accident victims assessed within one mont h of the trauma. Setting: ICU of the traumatology department at the University Hospital, Zur ich. Patients: 121 consecutive patients with accidental injuries (mean Injury Se verity Score, 21.8; mean Glasgow Coma Scale score, 14.4) admitted to the IC U between January 1996 and June 1997, aged 18-68 yrs. Patients with severe head injuries, attempted suicides, and victims of physical assault were exc luded. Measurements: Extensive clinical interview, Impact of Event Scale, Clinicia n-Administered Posttraumatic Stress Disorder Scale, social support, life ev ents, biographical protective and risk factors, Sense of Coherence question naire, Freiburg Questionnaire of Coping with Illness. Results:13,7 (SD, 6.8) days after the accident, 5 patients (4.1%) met all c riteria for posttraumatic stress disorder with the exception of the time cr iterion. A further 24 patients (19.9%) had subsyndromal posttraumatic stres s disorder. Posttraumatic psychiatric symptomatology did not correlate with objective injury criteria, but rather with pretrauma variables (female gen der, biographical risk and protective factors, life events), the patients' subjective appraisal of the severity and threat of the accident, their gene ral attitude toward life ("sense of coherence"), and their current coping s trategies. Surgeons' and nurses' global clinical appraisals did not correla te with injury severity or with the patients' coping strategies. Conclusions: Trauma surgeons and ICU personnel should pay special attention to the strains and stressors their patients have been exposed to when reco rding case histories and to the level of their patients' psychosocial adapt ation before the trauma.