Original ArticlePtsd in ambulant rta victims: A randomized controlled trial of debriefing
Introduction
Recent years have seen an increase in the number of reports dealing with psychiatric sequelae of road trauma. Studies of posttraumatic stress disorder (PTSD) in adults following road traffic accidents (RTAs) exclusively 1, 2, 3, 4 report prevalence rates from 7% to 39% over 1 to 18 months posttrauma—this variation reflecting methodological differences, including mixing of severe with mild injuries and inclusion of both hospitalized and ambulant cases. In children and adolescents, PTSD has also been reported as a common sequela of road trauma 5, 6. Immediately following RTAs, children and adults may suffer acute psychological stress reactions 1, 5 and degree of initial distress has been shown to predict short-term outcome in mixed trauma populations 5, 7, 8.
Although it is generally assumed that psychological debriefing (PD) is a useful prophylactic strategy with trauma victims [9] this hypothesis has not, until recently, been adequately tested 10, 11. Prior to the inclusion of PTSD in the diagnostic classification systems, two early studies investigated the prophylactic effect of crisis intervention on trauma victims and their relatives 12, 13. More recently randomized controlled trials of PD and its effect on PTSD have been reported 14, 15, 16. All studies to date fail to show that early debriefing prevents or minimizes either posttraumatic stress or PTSD. A recent trial of PD in RTA victims [14] used an hospitalized sample with some severe injuries. In this study, degree of injury and length of hospital stay turned out to be greater in the intervention than in the monitoring group: this disparity in baseline status could have distorted the findings. A similar disparity in randomized groups was reported by Bisson et al. [16] in a controlled trial of PD in burn trauma victims. Both of these recent studies failed to show that PD reduced subsequent morbidity. A previous study [3], which also failed to demonstrate a reduction in PTSD in counseled versus control RTA victims, delayed debriefing until 1 month postaccident, by which time PTSD could have been already established.
The present study of PTSD in ambulant RTA victims with minor injuries sought to avoid the methodological aforementioned pitfalls and incorporated a randomized trial of early psychological debriefing in the prediction of 3-month outcome.
Section snippets
Method
Forty consecutive trauma clinic attenders between the ages of 16 and 65 years were studied: all were involved in separate road traffic accidents and sustained minor injuries (excluding head injury) not requiring hospital admission. Subjects were randomly assigned to an intervention (n=18) or a monitoring group (n=22) by the toss of a coin. Baseline assessments of approximately 1.5-hour duration were performed at a mean of 7 days postaccident (range 3–14 days) and included recording of
Sample
There were 19 men and 21 women. Response rate at baseline was 100% with all individuals who fulfilled selection criteria consenting to assessment and follow-up. Trauma was confined to soft tissue injury with the exception of one subject with a fractured metatarsal. The majority of subjects (97.5%) was employed. Twenty-three (57.5%) were married. Three lived alone. Three had a previous psychiatric history of depression. Seven had begun litigation proceedings at baseline assessment. Whiplash
Initial distress and course of symptoms
This study appears to be the first to report prevalence of posttraumatic stress symptoms in nonhospitalized, ambulant RTA victims as early as 1 week postaccident. Our sample, however, is limited to those mildly injured RTA victims who attended the Accident and Emergency Department. Three fourths of the sample were significantly distressed at this early stage (IES “cases”), falling to about one third at 3 months. These findings are in keeping with those of Feinstein [8], who reported that 60% of
Acknowledgements
Acknowledgments—The authors thank Mr. A. Martin and the staff of the Accident and Emergency Department, University College Hospital, Galway, for their help and cooperation. The work by L.C. was in partial fulfillment of requirements for Mastership of Medical Science at the National University of Ireland in Galway.
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