Posttraumatic stress disorder mitigation in trauma patients: An evidence-based systematic review from the Eastern Association for the Surgery of Trauma

Susan Kartiko, From the Department of Surgery (S.K., J.A.), The George Washington University School of Medicine and Health Sciences, Washington, DC; Division of Trauma Surgery and Surgical Critical Care (R.R.), Legacy Emanuel Medical Center, Portland, Oregon; Department of Surgery (J.A.Z.), Center for Trauma and Critical Care, The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Surgery (L.C.T.), Northwestern University, Chicago, Illinois; Department of Surgery (L.P.), Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania; Technology Applications Center for Healthful Lifestyles, Departments of Nursing (K.J.R.) and Psychiatry (K.J.R.), Medical University of South Carolina, Charleston, South Carolina; James A. Zimble Learning Resource Center (P.L.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Himmelfarb Health Sciences Library (D.W., S.K.), The George Washington University, Washington, DC; Department of Surgery (H.M.), Jazan University, Saudi Arabia, Jazan, South Arabia; Department of Surgery (R.N.S.), Emory University School of Medicine, Grady Hospital System, Atlanta, Georgia; MUSC Turning the Tide Violence Intervention Program, Department of Surgery (A.B.H.), Medical University of South Carolina, Charleston, South Carolina; Boston University Chobanian and Avedisian School of Medicine (L.A.), Boston, Massachusetts; Department of Surgery (D.O.), Indiana University School of Medicine, Eskenazi Health Smith Level 1 Trauma Center, Indianapolis, Indiana; Department of Surgery (S.A.H.), Westside Hospital, Plantation, Florida; Department of Surgery (C.B.), Natividad Medical Center, Salinas, California; Division of Burn, Trauma, Acute and Critical Care Surgery, Department of Surgery (H.P.), University of Texas Southwestern Medical Center, Dallas, Texas; Division of Trauma and Acute Care Surgery (P.M.), Medical College of Wisconsin, Milwaukee, Wisconsin; and Division of Acute Care Surgery (A.L.T.), Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Jayati Atahar
Rishi Rattan
James A. Zebley
Leah C. Tatebe
Lindsey Perea
Kenneth J. Ruggiero
Paul Levett
Deborah Wassertzug
Susan Koenig
Hassan Mashbari
Randi N. Smith
Ashley B. Hink
Lisa Allee
Damaris Ortiz
Shaikh A. Hai
Caroline Butler
Hillary Prince
Patrick Murphy
Amanda L. Teichman

Document Type

Journal Article

Publication Date

5-13-2025

Journal

The journal of trauma and acute care surgery

DOI

10.1097/TA.0000000000004639

Keywords

PTSD; acute stress disorder; cognitive behavioral therapy; mental health

Abstract

BACKGROUND: Because of advances in trauma care, there has been increased survival among trauma patients. However, less progress has been made to address posttraumatic psychological disorders. Many trauma patients (19-42%) report emotional or psychological distress after injury, and over one in five will develop posttraumatic stress disorder (PTSD) and/or depression within the first postinjury year. We aim to establish a practice management guideline using a systematic review to provide guidance on early identification of individuals at risk for PTSD and evidence-based treatment options to assist our patients to mitigate the development of PTSD. METHODS: Clinically relevant questions regarding screening of and intervention for PTSD in adult trauma patients with clearly defined patient Population(s), Intervention(s), Comparison(s), and appropriately selected Outcomes were determined. A systematic literature review was conducted for the period of January 1, 1996, to September 9, 2023. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. The working group reached consensus on the final evidence-based recommendations. RESULTS: The literature search yielded 9,387 studies, of which 25 met the criteria for inclusion. Screening and interventions were mostly successful in the identification and management of acute stress disorder/PTSD. The use of cognitive behavioral therapy was the most successful therapy, especially when used with high-risk individuals. CONCLUSION: We conditionally recommend screening to identify patients at risk for PTSD during their initial hospitalization. We strongly recommend the use of cognitive behavioral therapy for mitigation of PTSD. LEVEL OF EVIDENCE: Systematic Review/Meta-analysis; Level II.

Department

Surgery

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