Early PTSD Risk Screening and Assessment in Craniofacial Trauma at a Level 1 Trauma Center: ITSS and Trauma-Related Predictors

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-9-2025

Abstract

Traumatic craniofacial injuries result in negative psychological sequelae. Studies report the prevalence of PTSD in maxillofacial trauma to be 27-41%. Although the DSM-5 requires persistent symptoms for 1 month for a formal PTSD diagnosis, early detection of high-risk individuals through screening and intervention is critical in reducing symptom severity and progression. At Corewell Health West, all patients admitted via trauma activation code receive the Inured Trauma Survivor Screening (ITSS) to screen for PTSD risk factors. This study aims to identify factors in craniofacial trauma that place patients at increased risk for PTSD.

A retrospective cohort analysis was conducted to identify craniofacial trauma patients via ICD-10 codes for craniofacial fractures. All patients with craniofacial fractures who received the ITSS survey following admission to the trauma service at Corewell Health West from June 2022 to January 2024 were included. Patients with a pre-existing PTSD diagnosis were excluded from this study. Patient charts were reviewed for demographic data, mechanism of injury, fracture type, operative management, and ITSS survey scores for PTSD risk evaluation. The data were analyzed using Wilcoxon rank sum, Chi-Square test, or Fisher's Exact. A p-value <0.05 was considered statistically significant.

248 patients met inclusion criteria for our study. The median age was 54 years-old (IQR: 33.0,72.5), and 66.1% were male. 90.7% of patients were admitted with a median hospital stay of 3 days (IQR: 2.0, 6.0). 22.9% of patients screened positive for PTSD risk via the ITSS survey. Of the facial fractures in patients who screened positive for PTSD risk, 9 (16.1%) were basilar skull, 2 (3.6%) malar, 5 (8.9%) mandibular, 12 (21.4%) nasal, and 24 (42.9%) sustained multiple facial fractures. Length of stay and mechanism of injury were significant predictors of PTSD risk. With every one day increase in length of stay, the odds of a positive PTSD risk score were 1.08 times that of a negative PTSD risk score (p-value = 0.0022). Injury via assault had significantly greater odds of positive PTSD risk compared to ground level fall (OR 6.65; 95% C.I.: 1.80-24.54; p=0.0162).

Craniofacial trauma is associated with high rates of PTSD specifically for patients who were assaulted. The ITSS has been an effective and efficient tool in screening for the risk of PTSD in this population. This study further supports the utility of this tool in the trauma setting, regardless of craniofacial fracture type. However, it can especially inform centers who do not make use of the ITSS to raise suspicion for PTSD risk in craniofacial trauma from assault and with increased length of stay.

Comments

2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1844

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