Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are common among trauma patients and caregivers – but only a small percentage of US trauma centers offer recommended assessment and education regarding stress disorders, reports a survey study in the September/October Journal of Trauma Nursing, official publication of the Society of Trauma Nurses. The journal is published in the Lippincott portfolio by Wolters Kluwer.
"Trauma patients are rarely assessed or educated about the potential effects of PTSD or ASD," according to the new research by Katherine E. Guess, MD, MPH, of University of Alabama at Birmingham School of Public Health and colleagues. "Assessment, education, and incidence of PTSD and ASD should be included as universally measured health outcomes across trauma centers."
Low rates of ASD and PTSD assessment in trauma patients and caregivers
The researchers surveyed US Level 1 trauma centers regarding their current levels of assessment and education of ASD and PTSD. Patients with ASD experience trauma-induced symptoms persisting for less than one month; those with PTSD have symptoms lasting a month or longer. Although exact rates are unknown, stress disorders are common in traumatized patients; estimates suggest that PTSD develops in 10 to 20 percent of adult trauma patients.
The American College of Surgeons recommends that trauma centers provide education and assessment for ASD and PTSD to all trauma patients. The study included responses from 122 adult and 55 pediatric Level 1 trauma centers.
Few trauma centers routinely assess for stress disorders in trauma patients, the survey results suggested. Only 25 percent of adult and 36 percent of pediatric trauma centers reported having protocols for assessing PTSD. Rates of protocols for assessing ASD were 12.5 percent in adult and 28 percent in pediatric trauma centers.
Education regarding stress disorders was infrequent as well – just 12 percent of adult and 20 percent of pediatric trauma centers had educational protocols regarding PTSD.
The trauma centers also offered minimal assessment and education for two other groups at high risk of stress disorders due to "second-hand" exposure to trauma: informal caregivers (such as family members and spouses) and formal caregivers (such as trauma nurses and doctors).
The survey also found that few trauma centers educated trauma nurses and physicians about stress disorders and the appropriate steps to take if they recognize these symptoms in their patients. When ASD/PTSD assessment and education took place, it was most often provided by bedside nurses, nurse practitioners, and social workers. "Nurses' ability to recognize these disorders may be imperative to diagnosis," the researchers write.
If left unchecked, ASD and PTSD has the potential to overwhelm a system that was primarily designed to treat the physical symptoms of trauma. We believe that stronger guidelines and policies would promote best practices in ASD and PTSD assessment and education in Level 1 trauma centers in the United States."
Dr. Katherine E. Guess and colleagues
"While PTSD/ASD has long been recognized as a danger to veterans post-war deployment, it has received minimal attention in the setting of civilian trauma care," comments Judy N. Mikhail, PhD, MBA, RN, Editor-in-Chief of Journal of Trauma Nursing. "PTSD and ASD are increasingly recognized as major threats to patient recovery following injury. This is a wake-up call for US trauma centers."
Guess, K. et al. (2019) A Survey of Level 1 Trauma Centers Regarding Posttraumatic Stress Disorder and Acute Stress Disorder. Journal of Trauma Nursing. doi.org/10.1097/JTN.0000000000000451.