Relationship Between Injury Severity Score & Post-traumatic Stress Disorder Among Orthopaedic Trauma Surgical Patients at the Kenyatta National Hospital

Abstract

Background: Major trauma has been defined and assessed using the Injury Severity Score (ISS). A total score of more than 16 has been linked to the development of post-traumatic stress disorder. Trauma is associated with psycho-social effects, especially among younger patients. With the increasingly higher survival rates of multiple trauma patients (85–88%), psychiatric consequences of trauma and subsequent surgical intervention have attracted much interest; studies in developed countries, applying different tools to assess injury severity, have demonstrated a relationship between the development of post-traumatic stress disorder with injury severity score, more so with increasing age, among women, and among patients who stay alone. There is, however, a paucity of data on the screening and integrated care for trauma patients in our setup, more so among orthopedic patients; hence the study to assess the prevalence of symptoms of post-traumatic stress disorder in patients who experienced orthopedic trauma at the Kenyatta National Hospital, Kenya. Objective: To determine the relationship between injury severity score and post-traumatic stress disorder among orthopedic trauma patients at the Kenyatta National Hospital in Kenya. Methodology: The study was cross-sectional, where ninety-eight patients from the orthopedic wards at the Kenyatta National Hospital were enrolled in the study. The principal investigator administered the Injury Severity Score tool at the time of admission using the patient records. The revised impact of the event scale tool was used to evaluate posttraumatic stress disorder at discharge. The socio-demographic parameters were collected from the patient’s files and a direct interviewee-administered questionnaire. These were recorded in a specially designed data collection tool. Coding and analysis were performed using the Statistical Package for Social Sciences version 24. Univariate analysis for the sociodemographic (age, gender, religion, level of education, employment status, marital status) and surgical variables (type of injury, injury score at admission, number of days in the hospital, cost of surgery, site of the body majorly affected) were done. Bivariate analysis was used for the post-traumatic stress symptoms and the association with socio-demographic and surgical characteristics. A p-value of 0.05 was applied. Results: Our study showed a weak positive relationship between the ISS score and the IES-R score. The Spearman rank correlation coefficient (ρ) was 0.016. However, the number of sites injured and the cause of injury were significantly associated with the IES-R score. Patients with more than two sites of injury had a mean IES-R score of 15.59 higher than that of those with one injury site, implying that the more the number of injury sites xiii a patient has results the higher the patient’s IES-R scores predicting the likely development of post-traumatic stress disorder in polytrauma patients. On average (median), the patients had an ISS score of 9, with the least being 1 (one) and the highest being 35. Regarding the IES-R score, the patients in this study had a median of 33.5, ranging from 0 (zero) to 77. Conclusion: Posttraumatic stress disorder is not uncommon among patients with orthopedic trauma and is associated with low socioeconomic income, number of sites injured & and cause of injury. Recommendation: The finding of predictors of PTSD at an early stage after accidents might be helpful in identifying high-risk patients for the development of PTSD especially amongst polytrauma victims for adequate management.