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ACS-induced PTSD linked to crowding in EDs
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Increased crowding in EDs may be associated with higher levels of ACS-induced post-traumatic stress disorder symptoms, according to a research letter published in JAMA Internal Medicine.
Researchers recorded time of presentation to the ED at a large teaching hospital in New York City for 135 participants (mean age, 63 years; 72% men; 23% black; 47% Hispanic) with ACS in the observational Prescription Use, Lifestyle, Stress Evaluation (PULSE) study between 2009 and 2011. They estimated degree of ED crowding exposure by calculating the number of ED admissions 12 hours before and 12 hours after each participant’s presentation time. Crowding was divided into tertiles for analysis.
Mean length of stay in the ED was 11 hours, according to the researchers. Among the study participants, 13% had STEMI; 32%, non-STEMI; 55%, unstable angina; and 33%, prior MI. Mean Global Registry of Acute Coronary Events score was 92.1; mean Charlson comorbidity index score was 1.8; and mean Beck Depression Index score was 8.4. The researchers also noted a left ventricular ejection fraction <40 in 60% of patients.
Results of a univariate analysis demonstrated an association between increasing tertiles of ED crowding and ACS-induced post-traumatic stress disorder (PTSD) symptoms at 1 month (B=2; P<.05). This association remained after adjustment for multiple variables (B=2.5; P=.01).
“A mechanism for the association of ED crowding to increased PTSD symptoms may be that a more chaotic environment may foster or inflate perceptions of increased life threat and decreased control, which may in turn contribute to greater acute psychological and physiological arousal,” the researchers wrote.
“Although our results are based on a small sample from a single ED, we believe they suggest the need for greater awareness of the influence of medical environments on patients’ psychological well-being, while underscoring the need for hospital administrators and policymakers to address ED overcrowding.”
Disclosure: The researchers report no relevant financial disclosures.
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