Cardiac patients' perceptions of neighboring patients' risk: influence on psychological stress in the ED and subsequent posttraumatic stress.
Cardiac patients' perceptions of neighboring patients' risk: influence on psychological stress in the ED and subsequent posttraumatic stress.
复制标题
DOI：
10.1186/s12873-017-0144-3
复制
发表时间：
2017-11-06
影响因子：
2.5
通讯作者：
Edmondson D
中科院分区：
文献类型：
--
作者：
Konrad B;Hiti D;Chang BP;Retuerto J;Julian J;Edmondson D
多达12%的急性冠状动脉综合征（ACS）患者因心脏事件而在创伤后应激障碍（PTSD）症状筛查中呈阳性，而急诊室（ED）的因素，如过度拥挤，与PTSD的风险有关。我们测试了在急性冠脉综合征的ED评估中，患者对自己与危重患者的接近程度的感知与出院后一个月内创伤后应激症状（PSS）的发展之间的关系。在对城市急诊科的ACS进行评估期间，参与者被纳入了对急性护理和住院的反应（REACH）研究。参与者报告了他们是否感觉到身边的病人接近死亡。他们还在急诊室感知问卷上报告了他们目前的恐惧、对自己可能死亡的担忧、感知到的控制和脆弱感。一个月后，参与者报告了与心脏事件和ED住院有关的PTSD症状。在763名参与者中，12%的人报告认为附近的病人可能会死亡。在多变量线性回归模型中[F(9757) = 19.69, p < 0.001， R2调整= 0.18]，校正了年龄、性别、GRACE心脏风险评分、出院ACS诊断、Charlson合并症指数、客观ED拥挤和基线抑郁症状，感知附近患者可能死亡与1个月PTSD评分增加2.33点（95% CI, 0.60-4.61）相关。事后中介分析与个人威胁感知(F (10756) = 25.28, p <措施,R2 = .24]显示调整增加个人威胁感知ED访问期间,B = 0.71分在PCL每点个人威胁感知调查问卷,β= 0.27,p =措施,充分促进协会的参与者的看法附近的病人可能死月创伤后应激障碍得分(ED威胁感知,调整后)B = 0.89(95%可信区间,1.33−3.12),β= 0.03,p =点,占调整效应的62%，导致主效应在统计上不显著。我们发现，认为附近有病人可能死亡的患者在1个月时出现明显更大的PTSD症状。意识到这种关联可能有助于设计ED患者管理程序，以识别和治疗关注acs后心理护理的患者。
As many as 12% of acute coronary syndrome (ACS) patients screen positive for post-traumatic stress disorder (PTSD) symptoms due to their cardiac event, and emergency department (ED) factors such as overcrowding have been associated with risk for PTSD. We tested the association of patients’ perceptions of their proximity to a critically ill patient during ED evaluation for ACS with development of posttraumatic stress symptoms (PSS) in the month after hospital discharge. Participants were enrolled in the REactions to Acute Care and Hospitalization (REACH) study during evaluation for ACS in an urban ED. Participants reported whether they perceived a patient near them was close to death. They also reported their current fear, concern they may die, perceived control, and feelings of vulnerability on an Emergency Room Perceptions questionnaire. One month later, participants reported on PTSD symptoms specific to the cardiac event and ED hospitalization. Of 763 participants, 12% reported perceiving a nearby patient was likely to die. In a multivariate linear regression model [F(9757) = 19.69, p < .001, R2 adjusted = .18] with adjustment for age, sex, GRACE cardiac risk score, discharge ACS diagnosis, Charlson comorbidity index, objective ED crowding, and depression symptoms at baseline, perception of a nearby patients’ likely death was associated with a 2.33 point (95% CI, 0.60–4.61) increase in 1 month PTSD score. A post hoc mediation analysis with personal threat perceptions [F(10,756) = 25.28, p < .001, R2 adjusted = .24] showed increased personal threat perceptions during the ED visit, B = 0.71 points on the PCL per point on the personal threat perception questionnaire, β = 0.27, p = .001, fully mediated association of participants’ perceptions of nearby patients’ likely death with 1-month PTSD score (after adjustment for ED threat perceptions,) B = 0.89 (95% CI, −1.33 to 3.12), β = 0.03, p = .43, accounting for 62% of the adjusted effect and causing the main effect to become statistically nonsignificant. We found patients who perceived a nearby patient was likely to die had significantly greater PTSD symptoms at 1 month. Awareness of this association may be helpful for designing ED patient management procedures to identify and treat patients with an eye to post-ACS psychological care.
登录
查看更多内容
影响因子：
3.7
作者：
Edmondson D;Richardson S;Falzon L;Davidson KW;Mills MA;Neria Y
通讯作者：
Neria Y
影响因子：
3.1
作者：
Homma, Kirsten;Chang, Bernard;Shaffer, Jonathan;Toledo, Barvina;Hefele, Brooke;Dalrymple, Nathan;Edmondson, Donald
通讯作者：
Edmondson, Donald
影响因子：
4.6
作者：
Edmondson, Donald
通讯作者：
Edmondson, Donald
影响因子：
4.5
作者：
Tian Y;Wong TK;Li J;Jiang X
通讯作者：
Jiang X
影响因子：
4.4
作者：
Compton, Scott;Grace, Heather;Swor, Robert A.
通讯作者：
Swor, Robert A.