Plastic Surgery Research Council

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The Incidence of PTSD and Depression in Adults with Operatively Treated Traumatic Brachial Plexus Palsy
Michael S. Gart, MD1, Risa T. Reid, MD2, Sarah N. Pierrie, MD3, Patrick Brannan, MD4, Bryan Loeffler, MD1, Glenn Gaston, MD1.
1OrthoCarolina Hand Center, Charlotte, NC, USA, 2Carolinas Medical Center, Charlotte, NC, USA, 3Brooke Army Medical Center, San Antonio, TX, USA, 4Elgin Air Force Base, Elgin AFB, FL, USA.

PURPOSE: Brachial plexus injuries not only result in physical disability and pain, but also psychological illnesses including depression and post-traumatic stress disorder (PTSD). There is a paucity of literature regarding the incidence of depression and PTSD in patients with brachial plexus injuries. We demonstrated that the incidence of depression and PTSD in patients with brachial plexus injuries is higher than previously reported.
METHODS: In this prospective, single-center study, all adult patients >18 years of age evaluated for traumatic brachial plexus injury from 2013-2018 were asked to complete the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Visual Analog Scale for Pain (VAS), Primary Care PTSD Screen (PC-PTSD), and the Center for Epidemiologic Studies Depression Scale (CES-D) as a part of each clinic visit. Patients requiring operative intervention were identified to determine the incidence of depression and PTSD in this population. Bivariate analysis was performed to identify variables that might influence the incidence data. Patients with a previous history of either depression or PTSD and/or current use of anti-depressant medications were excluded.
RESULTS: Between 2013 and 2018, ninety-nine patients underwent surgical intervention for traumatic brachial plexus injury. Of these, 72 had complete records for both PC-PTSD and CESD questionnaires. Average patient age was 45.8 years (range 18-75), median DASH score was 55.8, and median VAS score was 5. The overall incidence of depression was 40.3% (29/72), with males more likely to screen positive for depression than females (p=0.0465). The overall incidence of PTSD was 26.4% (19/72) and 94.7% of these patients were male. Patients with PTSD were significantly more likely to screen positive for depression (p<0.0001) and less likely to have full-time employment pre-injury (p=0.0407). 16 of 72 patients (22.2%) screened positive for concomitant depression and PTSD.
CONCLUSIONS: Traumatic brachial plexus injury has a significant impact on daily functioning and psychological well-being. The incidence of depression and PTSD in adults with traumatic brachial plexus injury requiring surgical treatment is higher than previously reported. This large sample size emphasizes the need for a multidisciplinary approach to treating these patients and may help to identify risk factors associated with PTSD and depression.


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