Psychological health status after major trauma across different levels of trauma care: A multicentre secondary analysis

Introduction: Concentration of trauma care in trauma network has resulted in different trauma populations across designated levels of trauma care.
Objective: Describing psychological health status, by means of the impact event scale (IES) and the hospital anxiety and depression scale (HADS), of major trauma patients one and two years post-trauma across different levels of trauma care in trauma networks.
Methods: A multicentre retrospective cohort study was conducted. Inclusion criteria: aged ≥ 18 and an Injury Severity Score (ISS) > 15, surviving their injuries one year after trauma. Psychological health status was self-reported with HADS and IES. Subgroup analysis, univariate, and multivariable analysis were done on level of trauma care and trauma region for HADS and IES as outcome measures. Results: Psychological health issues were frequently reported (likely depressed n = 31, 14.7 %); likely anxious n = 32, 15.2 %; indication of a post-traumatic stress disorder n = 46, 18.0 %). Respondents admitted to a level I trauma centre reported more symptoms of anxiety (3, P25-P75 1–6 vs. 5, P25-P75 2–9, p = 0.002), depression (2, P25-P75 1–5 vs. 5, P25-P75 2–9, p < 0.001), and post-traumatic stress (6, P25-P75 0–15 vs. 13, P25-P75 3–33, p = 0.001), than patients admitted to a non-level I trauma centre. Differences across trauma regions were reported for depression (3, P25-P75 1–6 vs. 4, P25-P75 2–10, p = 0.030) and post-traumatic stress (7, P25-P75 0–18 vs. 15, P25-P75 4–34, p < 0.001).
Conclusions: Major trauma patients admitted to a level I trauma centre have more depressive, anxious, and post-traumatic stress symptoms than when admitted to a non-level I trauma centre. These symptoms differed across trauma regions, indicating populations differences. Level of trauma care and trauma region are important when analysing psychological health status.