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, P-P 1-6 vs. 5, P-P 2-9, p = 0.002), depression (2, P-P 1-5 vs. 5, P-P 2-9, p < 0.001), and post-traumatic stress (6, P-P 0-15 vs. 13, P-P 3-33, p = 0.001), than patients admitted to a non-level I trauma centre. Differences across trauma regions were reported for depression (3, P-P 1-6 vs. 4, P-P 2-10, p = 0.030) and post-traumatic stress (7, P-P 0-18 vs. 15, P-P 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.