Post-traumatic stress disorder is underdiagnosed in people with burn injuries

"There is a need for preventive and screening measures to lower morbidity and early implementation of care in burned patients with PTSD," the researchers wrote in the study published in the journal Burns. They added, "These patients are at increased risk for depression, anxiety, pruritis, and sleep disorders."

Burns is a common phenomenon worldwide, particularly in low and middle-income countries, the global incidence of burns is 1.1 per 100,000 population per year in 2004 and 6-7 million per year in India alone. Fires and burns account for more than 300,000 patient deaths per year globally and are a major cause of disability-adjusted life years lost.

Post-traumatic stress disorder afflicts a significant portion of burn patients. Amina El Ayadi, Department of Surgery, University of Texas Medical Branch, University Boulevard, Galveston, TX, USA, and colleagues aimed to analyze the treatment and prevalence of PTSD in the burn population in a large administrative multi-institutional database. They also analyzed the mortality and morbidity of burn patients with PTSD compared to propensity-matched burn patients without PTSD.

For this purpose, they identified burn patients > 18 years of age without (A) or with (B) a PTSD diagnosis. Patients were stratified by per cent of total body surface area (TBSA) burned. In each cohort, mortality and morbidity were analyzed. Pharmacologic treatments and the prevalence of PTSD were analyzed from 2002 to 2022.

The study led to the following findings:

• There was an increase in PTSD incidence from 2.4% in patients with <10% to 3.1% in 10-30%, 7.4% in 30-59%, and 5.3% in >60% TBSA burned.
• In patients with <60% TBSA burned, PTSD diagnosis increased the risk of depression and anxiety.
• In patients with <30% TBSA burned, PTSD diagnosis also increased the risk of insomnia and pruritus.
• PTSD diagnosis was associated with a decreased risk of mortality in patients with >30% TBSA burned.
• The prevalence of PTSD in all burn patients was relatively stable between 2.2% and 3.2% from 2002 to 2022.
• There was an increase in the use of serotonergic agents and prazosin for the treatment of PTSD during this timeframe.

The findings suggest that on a national scale, PTSD may be underdiagnosed in the burn population. Those with severe burns and concomitant PTSD have an elevated risk of skin infections and related psychiatric issues

"Providers can use data from this study for expectations in treatment for those diagnosed with PTSD, development of preventive and screening measures to reduce morbidity and implement early care in those identified with PTSD," the researchers concluded.

Reference:

Iglesias, N., Campbell, M. S., Dabaghi, E., Prasai, A., Ben-Aissa, A., Ozhathil, D., Jay, J., Song, J., Golovko, G., Wolf, S., & El Ayadi, A. (2024). Post-Traumatic Stress Disorder in Burn Patients- a Large Database Analysis. Burns. https://doi.org/10.1016/j.burns.2023.12.016