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Heart rate measured in the acute aftermath of trauma can predict post-traumatic stress disorder: A prospective study in motor vehicle accident survivors

Published online by Cambridge University Press:  16 April 2020

R. Coronas ,
O. Gallardo ,
M.J. Moreno ,
D. Suárez ,
G. García-Parés  and
J.M. Menchón
R. Coronas*
Affiliation:
Corporació Sanitària Parc Taulí, Institut Universitari Fundació Parc Taulí-Universitat Autònoma de Barcelona (IUFPT-UAB), Sabadell, Spain
O. Gallardo
Affiliation:
Parc Taulí Accidents de Trànsit (Trafisaba), Sabadell, Spain
M.J. Moreno
Affiliation:
Corporació Sanitària Parc Taulí, Institut Universitari Fundació Parc Taulí-Universitat Autònoma de Barcelona (IUFPT-UAB), Sabadell, Spain
D. Suárez
Affiliation:
Epidemiology and Assessment Unit, Institut Universitari Fundació Parc Taulí-Universitat Autònoma de Barcelona (IUFPT-UAB), Sabadell, Spain
G. García-Parés
Affiliation:
Corporació Sanitària Parc Taulí, Institut Universitari Fundació Parc Taulí-Universitat Autònoma de Barcelona (IUFPT-UAB), Sabadell, Spain
J.M. Menchón
Affiliation:
Department of Psychiatry, University of Barcelona, Hospital de Bellvitge, L’Hospitalet de Llobregat, Spain
*
*Corresponding author. Psychiatry Department, Hospital de Sabadell, Parc Taulĩ 1, 08208 Sabadell, Barcelona, Spain. Tel.: +34 937231010/22171; fax: +34 937237181. E-mail address: [email protected] (R. Coronas).
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Abstract

Objective

To determine whether increased physiological arousal immediately after trauma or at emergency admission can predict post-traumatic stress disorder (PTSD) in motor vehicle accident (MVA) survivors with physical injuries.

Methods

We included 119 MVA survivors with physical injuries. In this prospective cohort study, heart rate (HR) and blood pressure (BP) were assessed during ambulance transport (T1) and at hospital admission (T2). One and four months after the accident, we assessed patients for PTSD (Davidson trauma scale, confirmed with the structured clinical interview for DSM-IV axis I disorders). Multivariate logistic regression models assessed the relationship between HR or BP and PTSD.

Results

PTSD was diagnosed in 54 (45.4%) patients at 1 month and in 39 (32.8%) at 4 months. In the multivariate analysis, HR at T1 or at T2 predicted PTSD at 1 month (OR=1.156, 95% CI [1.094;1.221] p < 0.0001). Only HR at T1 (not at T2) predicted PTSD at 4 months (OR=1.059, 95% CI [1.013; 1.108] p = 0.012). Injury severity predicted PTSD at 4 months (OR=1.207, 95% CI [1.085; 1.342] p = 0.001). A cut-off of 84 beats per minute yielded a sensitivity of 62.5% and a specificity of 75.0% for PTSD.

Conclusions

HR measured at the scene of MVA and severity of injury predicted PTSD 4 months later.

Keywords

PTSDMotor vehicle accidentsHeart rateBlood pressure
Type
Original article
Information
European Psychiatry , Volume 26 , Issue 8 , November 2011 , pp. 508 - 512
Copyright
Copyright © Elsevier Masson SAS 2011

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Footnotes

Abbreviations, MVA motor vehicle accidents, PTSD post-traumatic stress disorder, DSM-IV-TR diagnostic and statistical manual of mental disorders, 4th edition, SCID Istructured clinical interview for DSM-IV, DTS Davidson trauma scale, ISS injury severity score, GCS Glasgow coma scale, MMSE mini mental state examination, MINI mini-international neuropsychiatric interview

References

American Association for Automotive Medicine. The Abbreviated injury scale-revision. Des Plaines, Illinois: American Association for Automotive Medicine; 1990Google Scholar
Bedi, US, Arora, RCardiovascular manifestations of posttraumatic stress disorder. J Natl Med Assoc 2007;99(6):642–649[Review]Google ScholarPubMed
Blanchard, EB, Hickling, EJAfter the crash. Psychological assessment and treatment of survivors of motor vehicle accidents second editionWashington DC: American Psychological Association; 2004CrossRefGoogle Scholar
Blanchard, EB, Hickling, EJ, Galovski, T, Veazey, CEmergency room vital signs and PTSD in a treatment seeking sample of motor vehicle accident survivors. J Trauma Stress 2002;15(3):199–204.Google Scholar
Bobes, J, Calcedo-Barba, A, García, M, François, MEvaluation of the psychometric properties of the Spanish version of 5 questionnaires for the evaluation of post-traumatic stress [in Spanish]. Actas Esp Psiquiatr 2000;28(4):207–218.Google ScholarPubMed
Bryant, RAEarly predictors of posttraumatic stress disorder. Biol Psychiatry 2003; 53: 789–795.CrossRefGoogle ScholarPubMed
Bryant, RA, Creamer, M, O’Donnell, M, Silove, D, Clark, CR, McFarlane, ACPost-traumatic amnesia and the nature of post-traumatic stress disorder after mild traumatic brain injury. J Int Neuropsychol Soc 2009;15(6):862–867[Epub 2009 Aug 25]CrossRefGoogle ScholarPubMed
Bryant, RA, Creamer, M, O’Donnell, M, Silove, D, McFarlane, ACA multisite study of initial respiration rate and heart rate as predictors of posttraumatic stress disorder. J Clin Psychiatry 2008;69(11):1694–1701.CrossRefGoogle ScholarPubMed
Bryant, RA, Harvey, AG, Guthrie, RM, Moulds, MLA prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder. J. Abnorm Psychol 2000;109(2):341–344.Google Scholar
Bryant, RA, Harvey, AG, Guthrie, RM, Moulds, MLAcute psychophysiological arousal and posttraumatic stress disorder: a two-year prospective study. J Trauma Stress 2003;16(5):439–443.CrossRefGoogle ScholarPubMed
Bryant, RA, Marosszeky, JE, Crooks, J, Gurka, JAElevated resting heart rate as a predictor of posttraumatic stress disorder after severe traumatic brain injury. Psychosom Med 2004;66(5):760–761.CrossRefGoogle ScholarPubMed
Buckley, B, Nugent, N, Sledjeski, E, Raimonde, AJ, Spoonster, E, Bogart, LM, et al.Evaluation of initial posttrauma cardiovascular levels in association with acute PTSD symptoms following a serious motor vehicle accident. J Trauma Stress 2004;17(4):317–324.CrossRefGoogle ScholarPubMed
Charney, DS, Deutch, AY, Krystal, JH, Southwick, SM, Davis, MPsychobiological mechanisms of posttraumatic stress disorder. Arch Gen Psychiatry 1993;50(4):295–305.CrossRefGoogle Scholar
Chobanian, AV, Bakris, GL, Black, HR, Cushman, WC, Green, LA, Izzo, JL Jr., et al.The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003;289(19):2560–2572.CrossRefGoogle ScholarPubMed
Coronas, R, García-Pares, G, Viladrich, C, Santos, JM, Menchón, JMClinical and sociodemographic variables associated with the onset of posttraumatic stress disorder in road traffic accidents. Depress Anxiety 2008;25(5):E16–23.CrossRefGoogle ScholarPubMed
Darves-Bornoz, JM, Alonso, J, de Girolamo, G, de Graaf, R, Haro, JM, Kovess-Masfety, V, et al.Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey. J Trauma Stress 2008;21(5):455–462.CrossRefGoogle ScholarPubMed
Davidson, J.R.T., Book, SW, Colket, JT, Tupler, LA, Roth, S, David, D, et al.Assessment of a new self-rating scale for post-traumatic stress disorder. Psychol Med 1997; 27: 153–160.Google ScholarPubMed
Dimsdale, JEPsychological stress and cardiovascular disease. J Am Coll Cardiol 2008;51(13):1237–1246[Review]CrossRefGoogle ScholarPubMed
Ehlers, A, Mayou, RA, Bryant, BPsychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnorm Psychol 1998;107(3):508–519.CrossRefGoogle ScholarPubMed
Ehring, T, Ehlers, A, Cleare, AJ, Glucksman, EDo acute psychological and psychobiological responses to trauma predict subsequent symptom severities of PTSD and depression? Psychiatr Res 2008;161(1):67–75.Google ScholarPubMed
Enlow, MB, Kullowatz, A, Staudenmayer, J, Spasojevic, J, Ritz, T, Wright, RJAssociations of maternal lifetime trauma and perinatal traumatic stress symptoms with infant cardiorespiratory reactivity to psychological challenge. Psychosom Med 2009;71(6):607–614[Epub 2009 Jun 2]CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, J.B.W.Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version (SCID-CV) Washington DC: American Psychiatric Press Inc; 1997Google Scholar
Hall, RCDetection of malingered PTSD: an overview of clinical, psychometric, and physiological assessment: where do we stand? J Forensic Sci 2007;52(3):717–725[Review]CrossRefGoogle ScholarPubMed
Heim, C, Nemeroff, CBNeurobiology of posttraumatic stress disorder. CNS Spectr. 141 Suppl. 12009 13–24[Review]Google ScholarPubMed
Hendricks, HT, Heeren, AH, Vos, PEDysautonomia after severe traumatic brain injury. Eur J Neurol 2010[Epub ahead of print]Google ScholarPubMed
Hennes, H, Kim, MK, Pirrallo, RGPrehospital pain management: a comparison of providers’ perceptions and practices. Prehosp Emerg Care 2005;9(1):32–39.CrossRefGoogle ScholarPubMed
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EEPrevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62(6):617–627.CrossRefGoogle ScholarPubMed
Kraemer, B, Moergeli, H, Roth, H, Hepp, U, Schnyder, UContribution of initial heart rate to the prediction of posttraumatic stress symptom level in accident victims. J Psychiatr Res 2008;42(2):158–162.CrossRefGoogle ScholarPubMed
Kuhn, E, Blanchard, EB, Fuse, T, Hickling, EJ, Broderick, JHeart rate of motor vehicle accident survivors in the emergency department, peritraumatic psychological reactions, ASD, and PTSD severity: a 6-month prospective study. J Trauma Stress 2006;19(5):735–740.CrossRefGoogle ScholarPubMed
MacGregor, AJ, Corson, KS, Larson, GE, Shaffer, RA, Dougherty, AL, Galarneau, MR, et al.Injury-specific predictors of posttraumatic stress disorder. Injury 2009;40(9):1004–1010[Epub 2009 Jun 13]CrossRefGoogle ScholarPubMed
Matsuoka, Y, Nishi, D, Nakajima, S, Kim, Y, Homma, M, Otomo, YIncidence and prediction of psychiatric morbidity after a motor vehicle accident in Japan: the Tachikawa cohort of motor vehicle accident study. Crit Care Med 2008;36(1):74–80.Google ScholarPubMed
O’Donnell, ML, Creamer, M, Elliott, P, Bryant, RTonic and phasic heart rate as predictors of posttraumatic stress disorder. Psychosom Med 2007;69(3):256–261.CrossRefGoogle ScholarPubMed
Pastrana Jiménez, JI, Catalina Romero, C, García Diéguez, N, Lopez-Ibor Aliño, JJPharmacological treatment of acute stress disorder with propranolol and hypnotics. Actas Esp Psiquiatr 2007;35(6):351–358.Google ScholarPubMed
Pitman, RK, Delahanty, DLConceptually driven pharmacologic approaches to acute trauma. CNS Spectr 2005;10(2):99–106.CrossRefGoogle ScholarPubMed
Pole, NThe psychophysiology of posttraumatic stress disorder: a meta-analysis. Psychol Bull 2007;133(5):725–746.Google ScholarPubMed
Shalev, AY, Sahar, T, Freedman, S, Peri, T, Glick, N, Brandes, D, et al.A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder. Arch Gen Psychiatry 1998;55(6):553–559.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al.The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59Suppl. 201998 22–33[quiz 34–57. Review]Google ScholarPubMed
Southwick, SM, Bremner, JD, Rasmusson, A, Morgan, CA, Arnsten, A, Charney, DSRole of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder. Biol Psychiatry 3rd 1999;46(9):1192–1204[Review]Google ScholarPubMed
Teasdale, G, Jennett, BAssessment of coma and impaired consciousness. A practical scale. Lancet 1974;2(7872):81–84.CrossRefGoogle ScholarPubMed
Tombaugh, TN, McIntyre, NJThe mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992;40(9):922–935ReviewGoogle ScholarPubMed
Valentini, M, Parati, GVariables influencing heart rate. Prog Cardiovasc Dis 2009;52(1):11–19[Review]CrossRefGoogle ScholarPubMed
Wittchen, HU, Gloster, A, Beesdo, K, Schönfeld, S, Perkonigg, APosttraumatic stress disorder: diagnostic and epidemiological perspectives. CNS Spectr 141 Suppl.2009 5–12.Google ScholarPubMed
Wrenger, M, Lange, C, Langer, M, Heuft, G, Burgmer, JMPsychiatric disorders after an accident: predictors and the influence of the psychiatric condition prior to an accident. Eur Psychiatry 2008;23(6):434–440.CrossRefGoogle Scholar
Zatzick, DF, Russo, J, Pitman, RK, Rivara, F, Jurkovich, G, Roy-Byrne, PReevaluating the association between emergency department heart rate and the development of posttraumatic stress disorder: a public health approach. Biol Psychiatry 2005;57(1):91–95.Google ScholarPubMed
Zohar, J, Juven-Wetzler, A, Myers, V, Fostick, LPost-traumatic stress disorder: facts and fiction. Curr Opin Psychiatry 2008;21(1):74–77[Review]CrossRefGoogle ScholarPubMed
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