Comprehensive Assessment of Traumatic Injury

The nine-item Patient Health Questionnaire (PHQ)^{41 (link)} was used to assess depressive symptoms. The Alcohol Use Disorders Identification Test-Consumption Items (AUDIT-C)⁴² were used to assess alcohol use. The Medical Outcomes Study Short Form 36 (MOS SF-36) Physical Component Summary (PCS)⁴³ score was used to assess physical health and function. Prior trauma, PTSD symptoms, and pre-injury alcohol abuse/dependence were assessed with items from the National Co-morbidity Survey investigations.^{44 (link)} Previously developed items assessing post-injury health service use were administered at the baseline and at the one-, three-, six-, nine-, and twelve-month follow-up interviews.^{33 (link)} Interview items contained self-report descriptions of current medication usage (i.e., name, dosage, duration). We derived from these items the number of anti-depressant prescriptions, attainment of guideline dosages, and adequate adherence to guideline level doses for ≥ 25 or more days. Other medication categories included medications targeting insomnia related to PTSD (i.e., prazosin or trazadone). The number of psychotherapy visits was also assessed at each follow-up time point. Finally, items assessing satisfaction with general health care services and emotional health care services were included in all interviews.^{33 (link)}The investigation determined injury severity at baseline during the index admission from the medical record International Classification of Diseases, 9^th Revision, Clinical Modification (ICD-9-CM) Codes using the Abbreviated Injury Scale and Injury Severity Score.⁴⁵ TBI was also prospectively identified in the medical record and categorized by the following ICD-9-CM codes: 800.0–801.9, 803.0–804.9, 850.0–854.1, and 959.01.^{8 (link), 46 (link)} TBI severity was coded based on a previously validated algorithm for hospitalized inpatients.^{8 (link), 46 (link)} Laboratory toxicology results, insurance status, length of hospital and intensive care unit stays, and other clinical characteristics were abstracted from the trauma registry and electronic medical record.