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 >or=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.