Real-time screening tool for identifying post-traumatic stress disorder in facial trauma patients in a UK maxillofacial trauma clinic

Predictive risk factors of adverse mental health outcomes in the facial trauma patient

Patients with facial trauma often experience a psychological burden from their injuries. This study aimed to identify risk factors for adverse mental health outcomes in patients affected by facial trauma, using the 'Integrating Mental and Physical Healthcare: Research, Training and Services' (IMPARTS) screening tool. All patients >18 years of age who completed more than one IMPARTS screening tool in the Oral and Maxillofacial Trauma Clinic between 2019 and 2021 were included in this study. This tool was used to assess the risk of post-traumatic stress disorder (PTSD), generalized anxiety disorder, and depression. Included patients completed the IMPARTS questionnaire at initial follow-up (mean 18 days post-trauma) and one subsequent time point (mean 82 days). 167 patients were included in the study. On multivariable analysis, a history of psychiatric illness (P = 0.015) and interpersonal violence as the mechanism of injury (P = 0.010) were identified as predictive of risk of PTSD. Risk of PTSD was lower in zygomatic injuries (P = 0.001), while nasal involvement increased at-risk status for depression (P = 0.009). 47.3% of patients screened positive on initial IMPARTS assessment, while 35.3% screened positive on follow-up IMPARTS assessment. This study supports the IMPARTS tool in allowing the prompt identification of mental health adversity in facial trauma.

Reconsidering injury severity: Looking beyond the maximum abbreviated injury score

BACKGROUND

Injury severity is often determined by anatomical measures such as the Maximum Abbreviated Injury Score (MAIS). Yet, it is suggested that MAIS provides a limited view on injury severity as the overall burden of trauma is multidimensional, including psychological problems and health care costs for example. It is unclear if MAIS as a single criterion can serve as a proper indicator for overall injury severity, since it has not been compared with other severity measures for different types of injuries. Consequently, scientists and policymakers using MAIS as primary measure for injury severity may have insufficient information for prioritizing prevention policy and research. This study explores the relation between MAIS and other injury severity measures for ten different injury types to determine if MAIS is indicative for the overall burden of trauma.

METHODS

Trauma patients filled in a questionnaire six months after they visited an emergency department in the Netherlands. In total, 3.698 patients registered in the Dutch Injury Surveillance System responded. The following injury types are included: injuries to the head-brain, face, spinal cord, internal organs, upper and lower extremities, and hips. The questionnaire consisted of questions about the impact of patients' injury regarding quality of life (EQ-5D+), perceived severity, subjective distress (IES-R), anxiety and depression (HADS) and healthcare use.

RESULTS

Logistic regression showed that MAIS was significantly related to hospital stay, quality of life and cognitive complaints. A lack of association was found between MAIS and perceived severity, distress, anxiety and depression. Furthermore, Z-score analysis showed that the relation between severity measures differs between injury types.

CONCLUSIONS

MAIS is an anatomical-based discriminative measure for injury severity that correlates with several other severity measures including hospital stay and healthcare costs. However, MAIS is not always a proper indicator for severity when severity involves the patient's psychological burden or perceived health status. In sum, the accuracy of MAIS as an indicator for injury severity depends on the definition of severity and the injury type. Therefore, caution is needed when using and interpreting MAIS as an indicator for injury severity in research or policymaking.

The psychological sequelae of maxillofacial trauma: a scoping review of the literature

Managing the physical sequelae of facial trauma is routine for the maxillofacial surgeon. However, managing the psychological consequences is more challenging. The often violent mechanism of injury, changes in appearance, altered self-perception, and self-confidence can significantly impact daily life. This review summarises the literature regarding post-traumatic stress disorder (PTSD) and facial trauma, highlighting evidence to guide clinical practice. PubMed and MEDLINE were searched for relevant keywords and MeSH headings. Articles between 2000-2022 were independently reviewed by two authors. Articles were excluded if the full text was not available in English, did not relate to facial trauma, or was not related to PTSD/psychological sequelae. A total of 211 articles were retrieved. The most common reasons for exclusion were papers not reporting psychological outcomes (n = 68) or not relating to facial trauma (n = 35). Articles were sub-categorised to enable evaluation of key themes. Categories included children and adolescents, cross sectional, longitudinal studies, and interventional studies. Whilst there were potential confounders such as socioeconomic factors, overall, patients who had experienced facial trauma (regardless of the mechanism of injury) had an increased risk of PTSD and anxiety/depression. PTSD following facial injury is increasingly recognised as an important issue. A robust evidence base is desirable to inform clinical practice and provide holistic care to often vulnerable patients. Identifying those at increased risk of negative psychological sequelae is essential. We have appraised the literature relevant to OMFS trauma clinicians.