Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees

作者：Melcer Ted^*; Walker Jay; Bhatnagar Vibha; Richard Erin; Han Peggy; Sechriest V Franklin II; Lebedda Martin; Quinn Kimberly; Galarneau Michael

来源：Journal of Rehabilitation Research and Development, 2014, 51(5): 697-709.

DOI：10.1682/JRRD.2013.06.0143

• combat amputee
• fentanyl
• Glasgow Coma Scale
• Iraq/Afghanistan conflicts
• long-term psychological outcomes
• loss of consciousness
• military and VA health data
• morphine
• posttraumatic stress disorder
• traumatic brain injury

Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV) morphine (vs IV fentanyl) after injury was associated with reduced likelihood of posttraumatic stress disorder (PTSD). The previous results were based on military health diagnoses over 2 yr postinjury. The present study followed psychological diagnoses of patients with amputation for 4 yr using military and Department of Veterans Affairs health data. In-theater combat casualty records (n = 145) documented Glasgow Coma Scale (GCS) scores and/or morphine, fentanyl, or no opioid treatment within hours of injury. We found that (1) GCS scores were not significantly associated with PTSD; (2) longitudinal modeling using four (yearly) time points showed significantly reduced odds of PTSD for patients treated with morphine (vs fentanyl) across years (adjusted odds ratio = 0.40; 95% confidence interval = 0.17-0.94); (3) reduced PTSD prevalence for morphine (vs IV fentanyl; morphine = 25%, fentanyl = 59%, p < 0.05) was significant, specifically among patients with traumatic brain injury during the first 2 yr postinjury; and (4) PTSD prevalence, but not other disorders (e. g., mood), increased between year 1 (PTSD = 18%) and years 2 through 4 postinjury (PTSD range = 30%-32%).

• 出版日期2014