ABSTRACT
AIMS: The aims of this study were to determine if the severity of injury is related to the prevalence of posttraumatic stress disorder (PTSD) in polytrauma patients and to review the personality traits of patients with PTSD. METHODS: During 2006 and 2007, 252 polytrauma patients were treated at the Medical Centre Haaglanden in The Hague, The Netherlands. Of the 174 survivors, 53 adult patients were traced and sent questionnaires. They were screened for PTSD and personality traits, coping styles, and negative cognitions, and their level of social support were assessed. RESULTS: PTSD was demonstrated in 22.6% of the patients. CONCLUSIONS: An increased level of neuroticism, negative cognitions regarding themselves, and active dealing were found to be significant predictors of PTSD. However, we found no relation between the injury severity score and the prevalence of PTSD.
ABSTRACT
Patients with extensive burn injuries frequently require supplemental tube feeds in order to maintain caloric balance. Conventionally, nutrition is supplied via a naso-gastric tube (NGT). However, NGTs cause discomfort and numerous complications have been described, particularly following prolonged use. An alternative route to the gastro-intestinal tract comprises the percutaneous endoscopic gastrostomy (PEG) tube. This study describes by means of a retrospective analysis our experiences with the PEG tube in comparison with the NGT in a burn centre. Twelve burn patients, including two children and two patients with toxic epidermal necrolysis (TEN), were treated with a PEG tube. We could find no contra-indications to the placement of PEG tubes in this group. Placement of the tube through partial or full-thickness burn wounds did not give rise to complications. In a comparable group of 12 consecutive patients who were fed using a NGT, the NGT did give substantial discomfort to the patients and caused complications, especially in the patients with TEN. The complications that occurred during the use of a PEG tube were mainly caused by the small diameter, single-lumen design. Our experience suggests that the PEG tube is preferable to the NGT for patients who require prolonged feeding. For burn patients, modification of the design of the tube to include two exchangeable lumens of sufficient diameter, would improve performance.
