Posttraumatic concerns: a patient-centered approach to outcome assessment after traumatic physical injury.

Abstract:

BACKGROUND:Approximately 2.5 million Americans are admitted to the hospital after traumatic physical injury each year. Few investigations have elicited patients' perspectives regarding posttraumatic outcomes. OBJECTIVE:To identify and categorize physically injured trauma survivors' posttraumatic concerns. RESEARCH DESIGN:Prospective longitudinal investigation; trauma survivors were interviewed during the post-injury hospitalization and again 1, 4, and 12 months after the trauma. SUBJECTS:Ninety-seven, randomly selected, English speaking, hospitalized survivors of motor vehicle-crashes or assaults. MEASURES:At the end of each interview patients were asked, "Of all the things that have happened to you since you were injured, what concerns you the most?" Using an iterative process and working by consensus, investigators categorized patient concerns in content domains. Concern domains were then compared with established measures of posttraumatic stress disorder (PTSD) symptoms and limitations in physical functioning. RESULTS:Seven categories of posttraumatic concerns were identified. During the course of the year, 73% of patients expressed physical health concerns, 58% psychological concerns, 53% work and finance concerns, 40% social concerns, 10% legal concerns, 10% medical concerns, and 20% uncodable concerns. Rater agreement on concern categorization was substantial (kappa = 0.72). The mean number of concerns expressed per patient gradually decreased over time (1 month mean = 1.51; 12 month mean = 1.26) and resembled the trajectories of PTSD symptoms and functional limitations. CONCLUSIONS:The concerns of physically injured trauma survivors are readily elicited and followed up during the course of the year after injury. Open-ended inquiry regarding posttraumatic concerns may complement standardized outcome assessments by identifying and contextualizing the outcomes of greatest importance to patients.

journal_name

Med Care

journal_title

Medical care

authors

Zatzick DF,Kang SM,Hinton WL,Kelly RH,Hilty DM,Franz CE,Le L,Kravitz RL

doi

10.1097/00005650-200104000-00004

keywords:

subject

Has Abstract

pub_date

2001-04-01 00:00:00

pages

327-39

issue

4

eissn

0025-7079

issn

1537-1948

journal_volume

39

pub_type

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