A retrospective study of ketamine administration and the development of acute or post-traumatic stress disorder in 274 war-wounded soldiers
In a retrospective analysis of 274 surviving war‑wounded soldiers from Afghanistan, ketamine administration was not independently associated with development of acute or post‑traumatic stress disorder; multivariable regression identified only acute stress disorder and total number of surgical procedures as independent predictors of PTSD. Although a higher proportion of PTSD cases had received ketamine on unadjusted analysis, injury severity and other covariables accounted for that association.
Authors
- Mion, G.
- Masson, J. L.
- Granier, C.
Published
Abstract
Summary The objective of this study was to explore whether ketamine prevents or exacerbates acute or post‐traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010–2012). The diagnosis of post‐traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post‐traumatic and acute stress disorders with a p ≤ 0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post‐traumatic stress disorder and 89 (32%) had received ketamine. Fifty‐four patients (55%) in the post‐traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p < 0.001). The 89 injured soldiers who received ketamine had a median ( IQR [range]) injury severity score of 5 (3–13 [1–26]) vs. 3 (2–4 [1–6] in the 185 patients who did not (p < 0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post‐traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post‐traumatic stress disorder in the military trauma setting.
Research Summary of 'A retrospective study of ketamine administration and the development of acute or post-traumatic stress disorder in 274 war-wounded soldiers'
Introduction
Ketamine is widely used for pre-hospital anaesthesia in combat settings, but its effects on subsequent psychological sequelae of trauma are unclear. Acute stress disorder (ASD) and post‑traumatic stress disorder (PTSD) have distinct diagnostic windows and symptom clusters under DSM‑5: ASD occurs within days to a month after trauma and is a risk factor for PTSD, which is typically diagnosed 3–6 months later. Previous clinical reports have been conflicting: some observational work suggested peri-operative ketamine might reduce PTSD in burned soldiers, other analyses found no effect, and a randomised trial has reported ketamine can treat chronic PTSD symptoms. Mechanistically, ketamine has both psychomimetic and rapid antidepressant effects, and preclinical studies propose multiple neurobiological pathways by which it could either protect against or exacerbate stress‑related disorders. Mion and colleagues set out to examine whether ketamine administration to combat‑injured soldiers was associated with the subsequent development of ASD or PTSD. The primary objective was to assess the association between ketamine given to the war wounded and later PTSD; the secondary objective was to evaluate the relationship between ketamine and the incidence of ASD.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- APA Citation
Mion, G., Le Masson, J., Granier, C., & Hoffmann, C. (2017). A retrospective study of ketamine administration and the development of acute or post-traumatic stress disorder in 274 war-wounded soldiers. Anaesthesia, 72(12), 1476-1483. https://doi.org/10.1111/anae.14079
References (2)
Papers cited by this study that are also in Blossom
Mcghee, L. L., Maani, C. V., Garza, T. H. et al. · Journal of Trauma Injury Infection and Critical Care (2008)
Berman, R. M., Cappiello, A., Anand, A. et al. · Biological Psychiatry (2000)
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