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

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

• Ted Melcer, PhD Jay Walker, BA Vibha
  Bhatnagar, MD Erin Richard, MPH Peggy Han, MPH
  V. Franklin Sechriest II, MD Martin Lebedda,
  RN Kimberly Quinn, RN Michael Galarneau, MS,
  NREMT

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• Aim
• Use military and VA health data to investigate
  effect of early postinjury medications on 4 yr
  psychological outcomes of combat amputees.
• Relevance
• Morphine and fentanyl are frequently used for
  analgesia after trauma, but their advantages and
  disadvantages are debated.

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Method

• Retrospective review of existing medical records
  of U.S. combat amputees injured 2001-2008 in Iraq
  or Afghanistan.
• 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.

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Results

• GCS scores were not significantly associated with
  posttraumatic stress disorder (PTSD).
• Longitudinal modeling using 4 (yearly) time
  points showed significantly reduced likelihood of
  PTSD for patients treated with morphine (vs
  fentanyl).
• Reduced PTSD prevalence for morphine was
  significant, specifically among patients with
  traumatic brain injury during first 2 yr
  postinjury.
• PTSD prevalence, but not other disorders,
  increased between year 1 and years 2-4 postinjury.

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Conclusion

• Primary clinical implication
• Combat care physicians may consider PTSD
  prevention as potential benefit of choosing early
  morphine (with or without fentanyl) vs fentanyl
  alone
• Second implication
• Military and VA providers should screen for
  mental health disorders, particularly PTSD,
  during routine healthcare visits (e.g., primary
  care) for several years after injury.