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

J C Van Ditshuizen; M A C De Jongh; D Den Hartog; K W W Lansink; M H J Verhofstad; E M M Van Lieshout; BIOS-group; Dutch Trauma Registry Southwest; BIOS-groupDutch Trauma Registry Southwest

doi:10.1016/j.injury.2025.112152

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

Injury. 2025 Jan 9;56(2):112152. doi: 10.1016/j.injury.2025.112152. Online ahead of print.

Authors

J C Van Ditshuizen¹, M A C De Jongh², D Den Hartog³, K W W Lansink⁴, M H J Verhofstad⁵, E M M Van Lieshout⁵; BIOS-group; Dutch Trauma Registry Southwest; BIOS-groupDutch Trauma Registry Southwest

Collaborators

A H van der Veen⁶, C T Stevens⁷, D I Vos⁸, F C van Eijck⁹, H J A A van Geffen¹⁰, P V van Eerten¹¹, W A J J M Haagh¹², J B Sintenie¹³, L M S J Poelhekke¹⁴, N M R Soesman¹⁵, T S C Jakma¹⁶, M Waleboer¹⁷, M Staarink¹⁸, M M M Bruijninckx¹⁹, A Y M V P Cardon²⁰, P T den Hoed²¹, J Vermeulen²², C H van der Vlies²³, N W L Schep²⁴, L van de Schoot²⁵

Affiliations

¹ Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Trauma Centre Southwest-Netherlands, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. Electronic address: [email protected].
² Network Emergency Care Brabant, Brabant Trauma Registry, Tilburg, the Netherlands.
³ Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Trauma Centre Southwest-Netherlands, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
⁴ Network Emergency Care Brabant, Brabant Trauma Registry, Tilburg, the Netherlands; Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
⁵ Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
⁶ Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands.
⁷ Department of Surgery, Ziekenhuis Bernhoven, Uden, the Netherlands.
⁸ Department of Surgery, Amphia, Breda, the Netherlands.
⁹ Department of Surgery, Bravis Ziekenhuis, Roosendaal, the Netherlands.
¹⁰ Department of Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands.
¹¹ Department of Surgery, Maxima Medisch Centrum, Veldhoven, the Netherlands.
¹² Department of Surgery, St. Anna Ziekenhuis, Geldrop, the Netherlands.
¹³ Department of Surgery, Elkerliek Ziekenhuis, Helmond,the Netherlands.
¹⁴ Department of Surgery, Maasziekenhuis Pantein, Beugen, the Netherlands.
¹⁵ Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
¹⁶ Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
¹⁷ Department of Surgery, ADRZ, Goes, the Netherlands.
¹⁸ Department of Surgery, Het Van Weel-Bethesda Hospital, Dirksland, the Netherlands.
¹⁹ Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands.
²⁰ Department of Surgery, ZorgSaam Zeeuws-Vlaanderen Hospital, Terneuzen, the Netherlands.
²¹ Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands.
²² Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
²³ Burn Center, Maasstad Hospital, Rotterdam, the Netherlands.
²⁴ Department of Surgery, Spijkenisse Medisch Centrum Hospital, Rotterdam, the Netherlands.
²⁵ Department of Surgery, Beatrixhospital, Gorinchem, the Netherlands.

PMID: 39827530
DOI: 10.1016/j.injury.2025.112152

Abstract

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.

Keywords: Anxiety; Depression; Multiple trauma; Post-Traumatic; Stress Disorder; Trauma and stressor related disorders; Trauma centres.