S. Shahbazian1, M. Ditillo1, L. Bible2 1University Of Arizona, Department Of Surgery, Tucson, AZ, USA 2University Of Florida, Department Of Surgery, Gainesville, FL, USA
Introduction:
Use of ketamine for sedation and analgesia is increasing, especially following traumatic injury. Although there is evidence for ketamine’s use in chronic post-traumatic stress disorder (PTSD), there are studies associating early administration following traumatic experiences with increased risk for developing PTSD. Already following traumatic injuries, there is an estimated 10-30% incidence of PTSD. The purpose of this study is to evaluate the effect of ketamine exposure in the acute phase following traumatic injury on the incidence of positive PTSD screening for patients.
Methods:
The Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5) questionnaire is administered to all patients at their first trauma clinic visit following their hospitalization for trauma at our Level I trauma center. Retrospective chart review was conducted for each patient who completed the PCL-5 form August 2021 – February 2022. Data collected included amount and setting of ketamine administered, demographics, mental health history, mechanism of injury, Injury Severity Scores (ISS), number of surgeries, and days spent in ICU. A PCL-5 score of 31 or higher was considered a positive screening for PTSD. Multivariable logistic regression was performed to assess for contributing factors of screening positive for PTSD.
Results:
A total of 113 patients who completed the PCL-5 form were included in our study. Most patients, n=83 (73%), were male. Patients’ ages ranged from 18 to 78 (M=37.1, SD=16.7) with no significant difference in age between the group that did not versus did receive ketamine (p=0.795). Of the patient population, 43 (38%) received ketamine and 70 (62%) did not. The group of patients who received ketamine had worse injuries with a higher Injury Severity Score (M=18.79, SD=10.11) vs (M=12.09, SD=9.57), were more likely to be admitted to the ICU, and spent more days in the ICU (p=0.001). Only 20 patients (17%) overall screened positive for PTSD; 10 of whom received ketamine and 10 who did not. When comparing outcomes based on positive screening for PTSD, ketamine administration was not found to be a variable of significance (p=0.291). History of psychiatric illness of any kind (p=0.001) and penetrative injury mechanism (p=0.002) were found to be factors of influence for screening positive for PTSD.
Conclusion:
There is not a significant association between early ketamine administration following traumatic injury and screening positive for PTSD. Despite this, patients who experience physical trauma are at high risk for PTSD but there is historically poor follow-up for trauma patients; future evaluation of the success to accessing mental health services after referral will be important for improving patient outcomes.
