Shock index, hypotension, and blood product transfusion as predictors of post-traumatic stress disorder in firearm-related trauma.

Abstract

Gunshot wound survivors are at especially high risk for post-traumatic stress disorder. Early identification of patients at increased risk remains a major clinical challenge. Physiologic markers of injury severity, such as shock index and hypotension, are readily available during initial resuscitation and may help identify patients who could benefit from targeted mental health interventions. This exploratory study evaluates the association between markers of physiologic stress and post-traumatic stress disorder screening outcomes following gunshot wound injury. We retrospectively identified nonfatal gunshot wound patients screened for post-traumatic stress disorder at a single urban level I trauma center. We conducted multivariate Bayesian logistic regression with post-traumatic stress disorder as the binary outcome of interest. Predictor variables included shock index and hypotension, units of blood product transfusion, and demographic information. Our final cohort included 134 patients, of whom 39 (29%) screened positive for post-traumatic stress disorder. Increasing shock index (odds ratio, 1.2; 95% credible interval, 1.02-1.42; posterior probability of odds ratio >1, 99.2%) and the presence of hypotension (odds ratio, 4.0; 95% credible interval, 1.03-17.6; posterior probability of OR >1, 97.7%) were associated with a positive post-traumatic stress disorder diagnosis. Increasing units of blood product transfusion (odds ratio, 0.9; 95% credible interval, 0.77-0.97; posterior probability of OR <1, 99.7%) was associated with a negative post-traumatic stress disorder diagnosis. Increasing shock index and the presence of hypotension predict positive post-traumatic stress disorder screening in gunshot wound patients. These predictors potentially allow for early identification of high-risk patients, informing mental health resource allocation. The present associative findings should be interpreted cautiously and warrant validation in prospective studies.