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From Bedside to Bench: How the Epidemiology of Clinical Practice Can Inform the Secondary Prevention of PTSD

OBJECTIVE: Approximately 37 million acute care injury visits are made in the United States each year, and 2.5 million individuals are so severely injured that they require inpatient hospitalization. Few investigations have used pharmacoepidemiologic methods to determine which medications with strong theoretical support for secondary prevention of posttraumatic stress disorder (PTSD) are already in widespread use in acute care settings. METHODS: The investigators conducted a population-based assessment of medication administration for randomly selected adolescents (N=113) and adults (N=152) hospitalized at a level 1 trauma center after physical injury. Medication prescription at the time of surgical inpatient discharge was assessed by review of automated medical records. RESULTS: Opiate analgesic medications were prescribed to between 82 and 88 percent of injury survivors; 34 to 46 percent of patients also received nonopiate analgesic prescriptions. Between 11 and 16 percent of patients were prescribed antihistamines. Benzodiazepines, anticonvulsants, corticosteroids, beta-adrenergic blockers, and all other psychotropic medications were prescribed to less than 10 percent of adolescent and adult patients. CONCLUSIONS: Theoretical rationales exist for the testing of multiple compounds in the prevention of PTSD; pharmacoepidemiologic data inform which of these medications are already in widespread use and therefore may be most appropriate for testing in randomized trials. Efficacy trials and basic research could focus on the development of compounds that target both pain and anxiety for testing in the secondary prevention of PTSD after injury.

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