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Posttraumatic Stress Disorder in Combat Casualties With Burns Sustaining Primary Blast and Concussive Injuries

Mora, Alejandra G. BS; Ritenour, Amber E. MD; Wade, Charles E. PhD; Holcomb, John B. MD; Blackbourne, Lorne H. MD; Gaylord, Kathryn M. PhD, APRN, BC

The Journal of Trauma: Injury, Infection, and Critical Care: April 2009 - Volume 66 - Issue 4 - p S178-S185
doi: 10.1097/TA.0b013e31819ce2d6
Special Commentary

Background: There is a heightened focus on postexplosion functional outcomes in combat casualties. Previously, we reported a high prevalence of posttraumatic stress disorder (PTSD) (32%) and mild traumatic brain injury (mTBI) (41%) in patients with explosion-related burns. We hypothesized that the prevalence of PTSD in patients with burn was associated with primary blast injuries (PBIs) and mTBI.

Methods: We reviewed the records of 333 patients admitted consecutively to the United States Army Institute of Surgical Research burn center for explosion-related injuries between March 2003 and March 2006. By using the Posttraumatic Checklist, Military Version (PCL-M), patients were evaluated for PTSD symptoms (PCL-M score ≥44). Loss of consciousness defined mTBI. Patient data were analyzed in groups based on PTSD (yes or no), mechanism of injury (improvised explosive device [IED] vs. other explosive), PBI (yes or no), and mTBI (yes or no).

Results: Of 333 patients, 119 had PTSD assessments. Overall, PTSD was 22% (26 of 119). The prevalence of PTSD differed between mechanism of injury groups (p = 0.03). In the IED group (n = 105), 25% had PTSD symptoms and 18% had mTBI; patients injured by other explosive devices (n = 14) had no PTSD symptoms and one had mTBI (p = 0.04; p = 0.69, respectively). Also in the IED group, in patients with PBI, PTSD was 45% (9 of 20) compared with 20% (17 of 85) without PBI (odds ratio=3.27; 95% confidence interval, 1.17–9.16). More patients with PBI and mTBI (4 of 6; 67%) had PTSD symptoms compared with other patients (22 of 99; 22%) (odds ratio, 7.00; 95% confidence interval, 1.20–40.78). No other associations were found between PBI and mTBI.

Conclusion: IED-wounded burn patients with PBI and mTBI have a greater prevalence of PTSD. Patients who did not have IED-related injuries did not have PTSD and only one had mTBI.

From the United States Army Institute of Surgical Research, Fort Sam Houston, Texas.

Submitted for publication November 20, 2008.

Accepted for publication January 16, 2009.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Address for reprints: Kathryn M. Gaylord, PhD, APRN, BC, United States Army Institute of Surgical Research (USAISR), 3400 Rawley E. Chambers Road, Fort Sam Houston, TX 78234-6315; email:

© 2009 Lippincott Williams & Wilkins, Inc.