Journal of Rehabilitation Research & Development (JRRD)

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Volume 51 Number 5, 2014
   Pages 697 — 710

Abstract — Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees

Ted Melcer, PhD;1* Jay Walker, BA;1 Vibha Bhatnagar, MD;2–3 Erin Richard, MPH;2–3 Peggy Han, MPH;1 V. Franklin Sechriest II, MD;4 Martin Lebedda, RN;1 Kimberly Quinn, RN;1 Michael Galarneau, MS, NREMT1

1Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA; 2Department of Veterans Affairs San Diego Healthcare System, San Diego, CA; 3Department for Family and Preventive Medicine, University of California, San Diego, CA; 4Naval Medical Center San Diego, San Diego, CA

Abstract — Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV) morphine (vs IV fentanyl) after injury was associated with reduced likelihood of posttraumatic stress disorder (PTSD). The previous results were based on military health diagnoses over 2 yr postinjury. The present study followed psychological diagnoses of patients with amputation for 4 yr using military and Department of Veterans Affairs health data. 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. We found that (1) GCS scores were not significantly associated with PTSD; (2) longitudinal modeling using four (yearly) time points showed significantly reduced odds of PTSD for patients treated with morphine (vs fentanyl) across years (adjusted odds ratio = 0.40; 95% confidence interval = 0.17–0.94); (3) reduced PTSD prevalence for morphine (vs IV fentanyl; morphine = 25%, fentanyl = 59%, p < 0.05) was significant, specifically among patients with traumatic brain injury during the first 2 yr postinjury; and (4) PTSD prevalence, but not other disorders (e.g., mood), increased between year 1 (PTSD = 18%) and years 2 through 4 postinjury (PTSD range = 30%–32%).

Key words: combat amputee, fentanyl, Glasgow Coma Scale, Iraq/Afghanistan conflicts, long-term psychological outcomes, loss of consciousness, military and VA health data, morphine, posttraumatic stress disorder, traumatic brain injury.


View HTML ¦ View PDF ¦ Contents Vol. 51, No.5

This article and any supplementary material should be cited as follows:
Melcer T, Walker J, Bhatnagar V, Richard E, Han P, Sechriest VF 2nd, Lebedda M, Quinn K, Galarneau M. Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees. J Rehabil Res Dev. 2014;51(5):697–710.
http://dx.doi.org/10.1682/JRRD.2013.06.0143
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