Psychological health status after major trauma across different levels of trauma care: A multicentre secondary analysis

Introduction

Concentration of trauma care in trauma network has resulted in different trauma populations across designated levels of trauma care.

Objective

Describing psychological health status, by means of the impact event scale (IES) and the hospital anxiety and depression scale (HADS), of major trauma patients one and two years post-trauma across different levels of trauma care in trauma networks.

Methods

A multicentre retrospective cohort study was conducted. Inclusion criteria: aged ≥ 18 and an Injury Severity Score (ISS) > 15, surviving their injuries one year after trauma. Psychological health status was self-reported with HADS and IES. Subgroup analysis, univariate, and multivariable analysis were done on level of trauma care and trauma region for HADS and IES as outcome measures.

Results

Psychological health issues were frequently reported (likely depressed n = 31, 14.7 %); likely anxious n = 32, 15.2 %; indication of a post-traumatic stress disorder n = 46, 18.0 %). Respondents admitted to a level I trauma centre reported more symptoms of anxiety (3, P₂₅-P₇₅ 1–6 vs. 5, P₂₅-P₇₅ 2–9, p = 0.002), depression (2, P₂₅-P₇₅ 1–5 vs. 5, P₂₅-P₇₅ 2–9, p < 0.001), and post-traumatic stress (6, P₂₅-P₇₅ 0–15 vs. 13, P₂₅-P₇₅ 3–33, p = 0.001), than patients admitted to a non-level I trauma centre. Differences across trauma regions were reported for depression (3, P₂₅-P₇₅ 1–6 vs. 4, P₂₅-P₇₅ 2–10, p = 0.030) and post-traumatic stress (7, P₂₅-P₇₅ 0–18 vs. 15, P₂₅-P₇₅ 4–34, p < 0.001).

Conclusions

Major trauma patients admitted to a level I trauma centre have more depressive, anxious, and post-traumatic stress symptoms than when admitted to a non-level I trauma centre. These symptoms differed across trauma regions, indicating populations differences. Level of trauma care and trauma region are important when analysing psychological health status.