Prevalence and risk factors for acute stress disorder and posttraumatic stress disorder after burn injury

Prazosin for the treatment of nightmares in hospitalized adult burn patients

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) can occur after a traumatic event; they are characterized by, among other symptoms, hypervigilance, dissociation, nightmares, and flashbacks. Prazosin, an alpha-1 receptor antagonist, has been shown to be effective in reducing nightmares related to ASD and PTSD. Burn patients are particularly susceptible to acute and post-traumatic stress symptoms, especially nightmares. The goal of this study is to examine the benefits of prazosin in treating nightmares, one of the common symptoms of ASD and PTSD, among a cohort of adult burn patients during their hospitalization. We performed a retrospective analysis of 45 hospitalized burn patients who met eligibility criteria admitted between August 2014 and January 2024 who received prazosin to treat trauma-related nightmares. Descriptive statistics were used to characterize response of nightmares to prazosin and adverse effects from prazosin. Twenty-three (51.1 %) patients had full remission of nightmares, 16 (35.6 %) had some improvement in nightmares, and 6 (13.3 %) patients had no improvement in nightmares. Prazosin was well tolerated and there were no clinically significant changes in blood pressure or heart rate. This study suggests that prazosin may be beneficial for the treatment of nightmares associated with burn trauma in the hospital setting.

Prevalence of Post-traumatic Stress Disorder in Adult Burn Patients: A Study From Urban Tertiary Care Hospitals in Pakistan

Introduction Post-traumatic stress disorder (PTSD) is one of the main psychological conditions that develops after a traumatic event such as a burn injury. Patients often experience flashbacks, nightmares, anxiety attacks, and endless thoughts about the traumatic burn injury, which deteriorate their quality of life. These patients are usually socially isolated, have low self-esteem, and are more likely to commit suicide. Burn patients, who are particularly vulnerable, often do not receive adequate post-burn care, and psychological disorders like PTSD are often overlooked in developing nations such as Pakistan. Hence, this study investigated the prevalence of PTSD among adult burn patients in tertiary care hospitals and examined its distribution across different age groups, genders, and socioeconomic classes to highlight its overall burden as well as differences among these groups. Materials and methods This cross-sectional study was conducted from January 2024 to July 2024, recruiting 275 adult burn patients from tertiary care hospitals in Peshawar, Pakistan, using non-probability convenience sampling. Non-cooperative, unwilling, unconscious, and severe burn injury patients were excluded from the study. Additionally, individuals under the age of 18 years and those whose burn injuries occurred less than a month prior were omitted, as PTSD requires the traumatic event to have happened more than a month ago for diagnosis. All the burn patients were at different stages of recovery. A provisional diagnosis of PTSD was made by using the PTSD checklist for DSM-5, a 20-item checklist that assessed the symptoms of PTSD via a five-point Likert scale. The socioeconomic status was determined via a modified form of the Kuppuswamy Socioeconomic Status Scale. Results The diagnosis of PTSD was made in 52% (143 out of 275) of people who suffered burn injuries. The prevalence of PTSD in males and females was 40% (59 out of 148 males) and 66% (84 out of 127 females), respectively. Sixty-two percent of retirement-aged and 57% of middle-aged patients were mostly affected by PTSD. Similarly, PTSD was more prevalent in lower-class patients, i.e., 69% of patients with burn injuries from lower socioeconomic backgrounds were affected. Conclusion An alarmingly high prevalence of PTSD was found in burn patients. It was more prevalent in females than in males. A greater percentage of retirement-age and middle-aged adults were diagnosed with PTSD. When compared to patients from various socioeconomic backgrounds, burn patients from lower socioeconomic backgrounds were found to have a higher prevalence of PTSD.

Demoralization syndrome in burn patients: A cross-sectional study

AIMS

To investigate the status of demoralization syndrome and the factors affecting demoralization in burn patients.

METHODS

This study employed a cross-sectional research design and utilized a face-to-face questionnaire to gather data from adult burn patients with burn depths classified as second-degree or higher. The Demoralization Scale Mandarin Version, the Perceived Social Support Scale, the Herth Hope Index, and the Medical Coping Method Questionnaire were used to assess the level of demoralization, perceived social support, sense of hope, and coping strategies, respectively. General information, including socio-demographic data and disease characteristics, were collected. The patients' level of demoralization was categorized as the mean ± 1 standard deviation of the DS-MV scores. The data was analyzed using IBM SPSS 26.0 software to explore the relationship between the variables.

RESULTS

This study included 381 burn patients with a mean DS-MV score of 34.62 ± 18.319. Of these, 66 (17.3%) had mild demoralization, 241 (63.3%) had moderate demoralization, and 74 (19.4%) had severe demoralization. Cause of burn, total burn area, average monthly income of the individual, occupation, sense of hope, perceived social support, and medical coping strategies were the important factors associated with the severity of demoralization in burn patients.

CONCLUSIONS

Patients with burn injuries exhibit a notable prevalence and severity of demoralization indicating focused attention. By considering associated risk factors, healthcare professionals can devise and execute tailored intervention strategies aimed at mitigating the occurrence and intensity of demoralization in burn patients.

Acute stress disorder and associated factors among adult trauma patients in Ethiopia: a multi-institutional study

INTRODUCTION

Acute stress disorder (ASD) is a mental disorder that happens after someone experienced traumatic event within duration of less than a month. Other studies conducted in different countries revealed that adults with a trauma had experienced acute stress disorder. This results in substantial distress and interferes with social and day to day activities. Despite the high burden of this problem, very little is known about the prevalence and risk factors for acute stress disorder in adults with traumatic injuries in Ethiopia.

OBJECTIVE

This study was aimed to assess the prevalence of acute stress disorder and associated factors among adult trauma patients attending in northwest Amhara Comprehensive Specialized Hospitals, Ethiopia 2022.

METHODS

An institutional based cross-sectional study design was employed among 422 adult trauma patients from May- June 2022. Systematic sampling technique was applied to recruit study participants. Data were collected through interviewer administered questionnaires using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, acute stress disorder measurement tools. Then, it was entered into Epi-Data version 4 and exported to STATA version 14 for analysis. Bivariate and multivariable binary logistic regressions model were carried out to identify factors significantly associated acute stress disorder.

RESULT

The prevalence of acute stress disorder among adult trauma patients in northwest Amhara comprehensive specialized hospitals was found to be 44.15% (95% CI: 39.4%, 49.0%) with 99% of response rate. In multivariate logistic analysis younger age (21-29) (AOR = 0.33 95% CI: 0.14-0.77), (30-39) (AOR = 0.35 95% CI: 0.15-0.85), (40-49) (AOR = 0.28 95% CI: 0.10-0.76) respectively, presence of complication (AOR = 2.22 95% CI: 1.36-3.60), prolonged length of hospital stay (AOR = 1.89 95% CI: 1.21-2.95) and having low (AOR = 3.21, 95% CI: 1.66-6.19) and moderate (AOR = 1.99, 95%, CI: 1.14-3.48) social support were factors significantly associated with acute stress disorder.

CONCLUSION AND RECOMMENDATION

This study showed that the prevalence of acute stress disorder among the adult study participants who experienced traumatic events was high as compared to other literatures. Age, complication, prolonged hospital stay and social support were factors significantly associated with ASD at p-value < 0.05. This indicates the need for early identification and interventions or ASD care services from health workers of psychiatric ward.

Applications, opportunities, and challenges in using Telehealth for burn injury management: A systematic review

INTRODUCTION

Burns are global public health devastating and life-threatening injuries. Telehealth can be an appropriate answer for the effective utilization of health care resources, prevention referrals and reduce socio-economic burden of burns injuries. Thus, this study aimed to systematically evaluate the applications, opportunities, and challenges of using telehealth in burn injuries management.

METHODS

A structured search was conducted according to PRISMA statement guidelines in the Web of Science, PubMed, Scopus, and Science Direct as well as the Google Scholar for studies published until June 28, 2022. Of the total 2301 yielded studies, 36 articles were included in the final review. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis.

RESULTS

Patient triage, transfer, and referral (38.9%) follow-up (22%), care (22%), consultation (9%), education (3%), and rehabilitation (3%) were the most prevalent application of telehealth, respectively. Our findings identified 72 unique concepts, eight initial themes, and two clinical and administrative final themes for opportunities of using telehealth in burn injury management. Furthermore, we identified 27 unique concepts, three initial themes, and two clinical and administrative final themes for remaining challenges.

CONCLUSIONS

Despite providing pivotal opportunities such as improving burn injury diagnosis and quality of care, increasing patient and provider satisfaction, and cost containment using telehealth in burn injuries management, the concept faces challenges such as the impossibility of the physical examination of patients and technological difficulties. Our findings provide valuable information for policymakers and decision-makers infield of burn injuries and effective planning for using telehealth technology.

Understanding the Barriers and Enablers for Seeking Psychological Support following a Burn Injury

Burn injuries can be traumatic and distressing for patients, with a prolonged period of recovery. This qualitative study aimed to explore adult burn patients' perceptions of the barriers and facilitators to accessing psychological support in a Regional Burns Service in Southeast England. Participants (five females and six males) were under the care of the burns unit and were not currently accessing psychological support. Eleven semi-structured interviews were conducted. Responses were analysed using thematic analysis. Four main themes highlighted how access to psychology was influenced by communication between the patient and service, beliefs about mental health, environmental challenges, and patient hope. Recommendations for improving access to burn psychological care included (1) the provision of patient resources to increase awareness and reduce stigma; (2) psychological skills training to encourage staff to recognise distress and respond appropriately; (3) staff training in the practice of cultural humility; (4) increasing psychological presence in outpatient appointments and via routine follow-ups.