Capturing acute stress disorder in the trauma population

Abstract

Acute Stress Disorder (ASD) is classified as a psychiatric diagnosis that was first introduced to the DSM-IV in 1994. It was introduced to describe acute stress reactions that precede Post-Traumatic Stress Disorder (PTSD). ASD usually occurs within the first month after the occurrence of a traumatic event. Early recognition of ASD is crucial from both an early treatment standpoint and avoidance of progressing to PTSD, especially in the trauma population, as late recognition can lead to long-term mental and physical suffering. At this time, there is no protocol for screening of ASD upon admission to a Level I trauma center in the Southeast in the Unites States. Hence, not all trauma patients are assessed for ASD. Often, acute stress is recognized several days after admission, with late referrals to the psychiatric team for psychological evaluation and treatment. This late psychiatric referral often leads to the patient’s inability to participate in physical rehabilitation due to stress and anxiety, thus increasing hospital stay and use of resources. Thus, collaborating between the primary medical team and psychiatry team is essential and facilitates the recovery process for potential acute or long-term psychiatric disorders. To determine if ASD was recognized in the trauma population at a large Level I Trauma Center in the Southeast, and if referrals to psychiatry were initiated in a timely manner, this quality improvement study was developed. The data from this study served to correlate the percentage of patients who screened positive for ASD on admission to a sub-acute trauma floor.  A standardized tool called The Stanford Acute Stress Reaction Questionnaire (SASRQ) was used to determine the frequency of ASD in this trauma population. We also ascertained if the trauma nurse practitioners (NPs) had requested a psychiatric referral without the use of the SASRQ tool.  Findings included 18 of the 50 trauma patients who had screened positive for ASD (36%). It was found that of those 18 patients who screened positive for ASD, 2 patients received a psychiatric consultation for evaluation and treatment. These findings suggest a needed focus of capturing ASD early in the admission process, using a validated screening tool, along with early psychological intervention to aid in prevention of PTSD post-discharge.