Posttraumatic concerns: A patient-centered approach to outcome assessment after traumatic physical injury

BACKGROUND. Approximately 2.5 million Americans are admitted to the hospita l after traumatic physical injury each year. Few investigations have elicit ed patients' perspectives regarding posttraumatic outcomes. OBJECTIVE. To identify and categorize physically injured trauma survivors' posttraumatic concerns. RESEARCH DESIGN. Prospective longitudinal investigation; trauma survivors w ere interviewed during the post-injury hospitalization and again 1, 4, and 12 months after the trauma. SUBJECTS. Ninety-seven, randomly selected, English speaking, hospitalized s urvivors of motor vehicle-crashes or assaults. MEASURES. At the end of each interview patients were asked, "Of all the thi ngs that have happened to you since you were injured, what concerns you the most?" Using an iterative process and working by consensus, investigators categorized patient concerns in content domains. Concern domains were then compared with established measures of posttraumatic stress disorder (PTSD) symptoms and limitations in physical functioning. RESULTS. Seven categories of posttraumatic concerns were identified. During the course of the year, 73% of patients expressed physical health concerns , 58% psychological concerns, 53% work and finance concerns, 40% social con cerns, 10% legal concerns, 10% medical concerns, and 20% uncodable concerns . Rater agreement on concern categorization was substantial (kappa = 0.72). The mean number of concerns expressed per patient gradually decreased over time (1 month mean = 1.51; 12 month mean = 1.26) and resembled the traject ories of PTSD symptoms and functional limitations. CONCLUSIONS. The concerns of physically injured trauma survivors are readil y elicited and followed up during the course of the year after injury. Open -ended inquiry regarding posttraumatic concerns may complement standardized outcome assessments by identifying and contextualizing the outcomes of gre atest importance to patients.