Early referral of trauma patients to dedicated trauma psychology service: An observational study screening for post-traumatic stress disorder and depression

TL;DR

This study shows that early screening and referral for PTSD and depression in trauma patients improves over time and helps identify those at risk.

Contribution

The study demonstrates that integrating PTSD and depression screening into trauma care improves compliance and highlights gaps in patient referrals.

Findings

Screening compliance increased from 84% to 100% during the study period.

There was a 10% gap in referrals using the ITSS tool compared to the symptom checklist.

Direct referrals by trauma care staff could improve patient identification and mental health outcomes.

Abstract

The screening of post-traumatic stress disorder (PTSD) and depression after an injury is essential for improving the patient's quality of life. The aim of this study was to assess the utility of PTSD and depression screening and the early referral to the trauma psychology service at a level 1 trauma center. We hypothesized that as the screening process becomes more established as a standard of care, compliance with screening would improve. Furthermore, early referral of trauma patients to a dedicated psychologist within the trauma care system would be beneficial.

This retrospective study involved 1,245 consecutive eligible patients who were admitted to the trauma service between September 2019 and December 2020. The Injured Trauma Survivor Screen (ITSS) and an additional criteria checklist were used for patient screening, and data were analyzed. The screening was conducted within 24 hours of the admission of trauma patients aged  ≥ 14 years, all of whom had a Glasgow Coma Scale of 15.

The findings of the study showed that the integration of the new screening tool into a standard of care requires a significant amount of time. Screening compliance increased from 84% to 100% throughout the duration of the study. Notably, there was a 10% gap in the referral of patients identified through the ITSS tool, with 64% referrals based on the symptom checklist.

The current screening methods used as a standard of care show good utility value in identifying trauma patients predisposed to developing PTSD or depression, warranting their continued use. Facilitating direct referrals to trauma psychology service by attending staff, including nurses, could help bridge the gap in patient identification and referral. However, further research is warranted to validate this process.

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