• Douglas F Zatzick, Frederick P Rivara, Gregory J Jurkovich, Charles W Hoge, Jin Wang, Ming-Yu Fan, Joan Russo, Sarah Geiss Trusz, Avery Nathens, and Ellen J Mackenzie.
• Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, 98104, USA. dzatzick@u.washington.edu
• Arch. Gen. Psychiatry. 2010 Dec 1;67(12):1291-300.

ContextFew large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI).ObjectivesTo understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity.DesignMultisite US prospective cohort study.SettingEighteen level I trauma centers and 51 non-trauma center hospitals.PatientsA total of 3047 (weighted n = 10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years.Main Outcome MeasuresSeverity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury.ResultsAt the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD.ConclusionsMore severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.

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