Glasgow Coma Scale scores, early opioids, and 4-year psychologicaloutcomes among combat amputees Ted 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.