Research

Long-term prevalence of post-traumatic stress disorder symptoms in patients after secondary peritonitis

Kimberly R Boer¹ , Cecilia W Mahler² , Cagdas Unlu² , Bas Lamme² , Margreeth B Vroom³ , Mirjam A Sprangers⁴ , Dirk J Gouma² , Johannes B Reitsma¹ , Corianne A De Borgie¹ and Marja A Boermeester²

¹Department of Clinical Epidemiology & Biostatistics, Academic Medical Center, Amsterdam, The Netherlands

²Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

³Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands

⁴Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands

author email corresponding author email

Critical Care 2007, 11:R30doi:10.1186/cc5710

Published:	23 February 2007

See related commentary by Weinert and Meller, http://ccforum.com/content/11/1/118, related research by Jackson et al., http://ccforum.com/content/11/1/R27, and related research by Girard et al., http://ccforum.com/content/11/1/R28

Abstract

Introduction

The aim of this study was to determine the long-term prevalence of post-traumatic stress disorder (PTSD) symptomology in patients following secondary peritonitis and to determine whether the prevalence of PTSD-related symptoms differed between patients admitted to the intensive care unit (ICU) and patients admitted only to the surgical ward.

Method

A retrospective cohort of consecutive patients treated for secondary peritonitis was sent a postal survey containing a self-report questionnaire, namely the Post-traumatic Stress Syndrome 10-question inventory (PTSS-10). From a database of 278 patients undergoing surgery for secondary peritonitis between 1994 and 2000, 131 patients were long-term survivors (follow-up period at least four years) and were eligible for inclusion in our study, conducted at a tertiary referral hospital in Amsterdam, The Netherlands.

Results

The response rate was 86%, yielding a cohort of 100 patients; 61% of these patients had been admitted to the ICU. PTSD-related symptoms were found in 24% (95% confidence interval 17% to 33%) of patients when a PTSS-10 score of 35 was chosen as the cutoff, whereas the prevalence of PTSD symptomology when borderline patients scoring 27 points or more were included was 38% (95% confidence interval 29% to 48%). In a multivariate analyses controlling for age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, number of relaparotomies and length of hospital stay, the likelihood of ICU-admitted patients having PTSD symptomology was 4.3 times higher (95% confidence interval 1.11 to 16.5) than patients not admitted to the ICU, using a PTSS-10 score cutoff of 35 or greater. Older patients and males were less likely to report PTSD symptoms.

Conclusion

Nearly a quarter of patients receiving surgical treatment for secondary peritonitis developed PTSD symptoms. Patients admitted to the ICU were at significantly greater risk for having PTSD symptoms after adjusting for baseline differences, in particular age.