this article and any supplementary material should be cited as follows: melcer t, walker j,...

This article and any supplementary material should be cited as follows: Melcer T, Walker J, Bhatnagar V, Richard E, Han P, Sechriest VF 2nd, Lebedda M, Quinn K, Galarneau M. Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees. J Rehabil Res Dev. 2014;51(5):697–710. http://dx.doi.org/10.1682/JRRD.2013.06.0143

Slideshow ProjectDOI:10.1682/JRRD.2013.06.0143JSP

Glasgow Coma Scale scores, early opioids, and 4-year psychological

outcomes among combat amputeesTed 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



• 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.



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.



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.



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.

this article and any supplementary material should be cited as follows: melcer t, walker j,...

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