A brief, stepped, collaborative care intervention program, provided to patients with acute injuries with initial post-traumatic stress disorder (PTSD) symptoms, was associated with a greater reduction in symptoms 6 months after injury compared to usual care. This was what researchers discovered from the Trauma Survivors Outcomes and Support pragmatic clinical trial conducted at the University of Washington’s Harborview Medical Center in collaboration with the National Institutes of Health Care Systems Research Collaborator. The authors published their findings in JAMA Surgery.
The stepped-wedge cluster randomized clinical trial was conducted at 25 United States level I trauma centers. The researchers assessed patients at baseline when they were trauma inpatients and again 3, 6, and 12 months post-injury. They used various questionnaires to assess PTSD symptoms at and after injury. The trial included 635 participants evenly split between men (51.5%) and women (48.5%).
Mixed model regression analyses revealed statistically significant changes in PTSD symptom scores for intervention patients compared with the control group at 6 months, but not at 3 or 12 months after injury. “This pattern of treatment response can be explained in part by the observation that approximately 90% of intervention activity occurred in the first 6 months after the injury,” the researchers stated.
Intervention patients demonstrated about 5% greater 10-point PTSD assessment score reductions at each follow-up time compared to the control group. Patients with firearm injuries had the greatest 6-month improvement.
Limitations of this study include intervention patients having higher PTSD symptom levels at baseline compared to the control group — regression to the mean could explain treatment effects. Also, because of multiple traumatic life events, many patients experienced ongoing PTSD symptoms even after brief collaborative care.
“The results of this 25-site pragmatic trial corroborate and extend previous reports demonstrating that stepped collaborative care may be an optimal intervention approach for injury survivors treated at trauma centers,” the researchers stated. “The present trial extends these earlier observations by demonstrating that a brief collaborative care intervention can be feasibly delivered by front-line trauma center clinicians and is effective when well implemented.”
Zatzick D, Jurkovich G, Heagerty P, et al. Stepped collaborative care targeting posttraumatic stress disorder symptoms and comorbidity for US trauma care systems: A randomized clinical trial. JAMA Surg. Published online March 10, 2021. doi:10.1001/jamasurg.2021.0131