Statement on Post-Traumatic Stress Disorder in Adults

The American College of Surgeons (ACS) Committee on Trauma (COT), through its Subcommittee on Injury Prevention and Control, prepared the following Statement on Post-Traumatic Stress Disorder in Adults to educate surgeons and other medical professionals on the significance of post-traumatic stress disorder (PTSD) and the mental health impact of trauma. The ACS Board of Regents approved this statement at its October 2017 meeting in San Diego, CA.

The ACS recognizes the following facts:

• PTSD is a state of anxiety following a physical or psychological traumatic incident that includes symptoms of extreme fear, anxiety, insomnia, helplessness, and recurring memories that may result in avoidance of people, places, or objects associated with the event. Symptoms lasting longer than 30 days after the event are considered to be PTSD.
• Epidemiologic investigation at U.S. trauma centers demonstrates that approximately 20–40 percent of injured trauma survivors experience high levels of PTSD and/or depressive symptoms during the year following injury.^1-3
• A series of investigations now demonstrates a strong relationship between the symptoms of PTSD, depression, and functional impairments after injury.^1-3
• Victims of interpersonal violence have an increased risk of PTSD.^4-7

The ACS supports efforts to promote, enact, and sustain legislation and policies that encourage:

• Implementing a screening/referral protocol into the care of trauma patients using an evidence-based tool, such as the Primary Care PTSD screen (PC-PTSD), PTSD Checklist–Civilian version (PCL-C), and integration of the protocol into the electronic health record^8-10
• Implementing hospital-based violence intervention programs with a mental health component in hospitals that care for those individuals injured as a result of interpersonal violence¹¹
• Enhanced research funding to better understand PTSD and depression following injury, and to identify best methods of alleviating the symptoms and their sequelae

References

1. Holbrook TL, Hoyt DB, Coimbra R, Potenza B, Sise M, Anderson JP. Long-term posttraumatic stress disorder persists after major trauma in adolescents: New data on risk factors and functional outcome. J Trauma. 2005;58(4):764-769.
2. Shih RA, Schell TL, Hambarsoomian K, Belzberg H, Marshall GN. Prevalence of posttraumatic stress disorder and major depression after trauma center hospitalization. J Trauma. 2010;69(6):1560-1566.
3. Zatzick D, Jurkovich GJ, Rivara FP, et al. A national U.S. study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury. Ann Surg. 2008;248(3):429-437.
4. Powers MB, Warren AM, Rosenfield D, et al. Predictors of PTSD symptoms in adults admitted to a level I trauma center: A prospective analysis. J Anxiety Disord. 2014;28(3):301-309.
5. Warren AM, Foreman ML, Bennett MM, et al. Posttraumatic stress disorder following traumatic injury at 6 months: Associations with alcohol use and depression. J Trauma. 2014;76(2):517-522.
6. Alarcon LH, Germain A, Clontz AS, et al. Predictors of acute posttraumatic stress disorder symptoms following civilian trauma: Highest incidence and severity of symptoms after assault. J Trauma. 2012;72(3):629-635.
7. Resse C, Pederson T, Avila S, et al. Screening for traumatic stress among survivors of urban trauma. J Trauma Acute Care Surg. 2012;73(2):462-468.
8. Wong EC, Schell TL, Marshall GN, Jaycox LH, Hambarsoomians K, Belzberg H. Mental health service utilization after physical trauma: The importance of physician referral. Med Care. 2009;47(10):1077-1083.
9. Hanley J, de Roon-Cassini T, Brasel K. Efficiency of a four-item posttraumatic stress disorder screen in trauma patients. J Trauma. 2013;75(4):722-727.
10. Russo J, Katon W, Zatzick D. The development of a population based screening procedure for PTSD in acutely injured hospitalized trauma survivors. Gen Hosp Psych. 2013;35(5):485-491.
11. Purtle J, Dicker R, Cooper C, et al. Hospital-based violence intervention programs save lives and money. J Trauma Acute Care Surg. 2013;75(2):331-333.