The course, prediction and treatment of acute and post-traumatic stress in trauma patients: A systematic review.

Background: Trauma patients suffer from Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD). It is unknown how these disorders develop over time and when treatment is effective. Our aim was to systematically review (i) the course and predictors of ASD and PTSD after trauma and (ii) which and when psychological treatments are effective. Methods: Embase, Medline, Web of Science, Scopus, PsycInfo, Cinahl, Cochrane, Pubmed, and Google Scholar were searched up to September 14, 2015. Quality was assessed with STROBE and CONSORT checklists. Results: Overall, 49 (69%) observational studies and 22 (31%) intervention studies were included. Fifty studies (70%) were of lower (Level of Evidence (LoE) 3) or poor quality (LoE 4). ASD was present during hospitalization (range 1%-37%) and about 30% experienced PTSD one month after trauma (LoE 3). The onset of PTSD was within three months up to 12 months after trauma (LoE 3). Especially in patients with ASD, patients showed PTSD symptoms after six years (LoE 3). ASD and PTSD were associated with socio-demographic factors (e.g. being female, younger age, financial problems and low income), reduced cognitive functioning, physical (e.g. pain), social (e.g. low social support), and psychological problems (e.g. hyper-arousal) or disorders (e.g. ASD). Early treatment in the first weeks after trauma can be preventive for PTSD, but effective treatment for ASD is still unclear. Compared to other psychological treatments, the most common examined treatment for PTSD was Cognitive Behavioral Therapy (CBT), which seems to be effective (LoE 2). Conclusions: A large number of poor qualitative studies present inconsistent findings on the course of ASD and PTSD. Predictors for ASD and PTSD were identified. Early treatment can prevent PTSD. CBT is effective, but mostly examined and it has limitations (e.g. engagement). Other intervention studies are necessary. Good qualitative observational and intervention studies are lacking and needed. Level of evidence: III, study type: systematic review and meta-analyses (C) 2017 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2n1mro8