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Screening for Posttraumatic Stress Disorder in Civilians With Mangled Hand Injury: A Practice Enhancement Approach
Ruth A Cook1, Marie-Annette Brown, Christopher Allan
1Ruth A. Cook, DNP, ARNP, Harborview Hand Institute, Hand, Elbow & Shoulder Center at Harborview, Seattle. Marie-Annette Brown, PhD, ARNP, FAAN, University of Washington School of Nursing, Seattle. Christopher Allan, MD, Hand, Elbow & Shoulder Center at University of Washington Medical Center-Roosevelt, Seattle. Karen Schepp, PhD, RN, PMHCNS-BC, FAAN, University of Washington School of Nursing, Seattle. Joachim G. Voss, PhD, RN, ACRN, FAAN, Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH.
Posttraumatic stress disorder (PTSD) screening identified 40% of mangled hand injury patients as "at risk," but only 22% received referrals. A new protocol aims to improve early detection and treatment for PTSD after severe hand trauma.
Area of Science:
- Trauma Surgery
- Psychiatry
- Rehabilitation Medicine
Background:
- Posttraumatic stress disorder (PTSD) is a common and often untreated consequence of physical trauma, particularly severe injuries like mangled hands.
- Early identification and treatment of PTSD are crucial as chronic forms are more difficult to manage.
- Mangled hand injuries significantly impact patients' social integration and body image, increasing vulnerability to psychological distress.
Purpose of the Study:
- To assess the prevalence of PTSD screening and referral practices for patients with mangled hand injuries at a major trauma center.
- To identify deficits in the current system for managing PTSD in this patient population.
- To implement a revised screening protocol to improve PTSD detection and treatment initiation.
Main Methods:
- A retrospective review of medical records from January to December 2012 was conducted.
- An existing PTSD screening tool was utilized to evaluate patients with mangled hand injuries.
- Data on screening results and subsequent referrals to rehabilitation psychiatry were analyzed.
Main Results:
- 40% of patients with mangled hand injuries screened positive for PTSD risk.
- Alarmingly, only 22% of these at-risk patients were referred for further psychiatric evaluation and treatment.
- This highlights a significant gap in care for PTSD following severe hand trauma.
Conclusions:
- Current PTSD screening and referral practices for mangled hand injuries are inadequate.
- The implementation of a new, standardized screening protocol using the 4-item Primary Care-PTSD tool and patient education is expected to improve care.
- The goal is to ensure all patients with positive PTSD screens receive timely psychiatric referrals for effective management.
