ASSOCIATION OF INJURY SEVERITY SCORE WITH DEVELOPMENT OF ACUTE STRESS REACTIONS IN TRAUMA PATIENTS
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Keywords
Injury Severity Score; Acute Stress Reaction; Trauma; Psychological Outcomes
Abstract
: Acute Stress Reaction (ASR) is common among trauma patients and can slow physical recovery while worsening psychological distress. The Injury Severity Score (ISS) is widely used to quantify the extent of bodily trauma. Understanding the relationship between ISS and acute stress responses may help identify high-risk patients and guide timely psychological and medical interventions.
Objectives: To determine the association between ISS and the presence of ASR among adult trauma patients, and to assess whether increasing ISS values predict a higher likelihood of developing acute psychological distress following traumatic injury.
Methodology: This prospective observational study conducted at Department of Surgery, Islamic International Medical College, Rawalpindi from July 2023 to Dec 2023 included adult trauma patients presenting to the hospital within 24 hours of injury. Injury severity was assessed using the Abbreviated Injury Scale (AIS) to calculate ISS. ASR was diagnosed using ICD-11 criteria within 72 hours of admission. Demographic and clinical data were recorded. Statistical analysis was performed using SPSS version 24. Associations were evaluated using Chi-square tests, independent t-tests, and logistic regression.
Results: A total of 150 trauma patients were enrolled, with a mean age of 33.9 ± 11.8 years; 71.3% were male. Road traffic crashes were the most common mechanism of injury (67.4%). The mean ISS was 18.6 ± 7.4. ASR was identified in 61 patients (40.7%). Patients with ASR had significantly higher ISS scores (23.1 ± 6.1) compared with ASR-negative patients (15.4 ± 5.0; p = 0.001). A clear dose-response pattern was observed: ASR prevalence increased with rising ISS categories—10% for ISS < 9, 21% for ISS 9–15, 45% for ISS 16–24, and 62% for ISS ≥ 25. Logistic regression confirmed ISS as a strong independent predictor of ASR.
Conclusion: Higher ISS levels are significantly associated with an increased likelihood of developing ASR in trauma patients. Early psychological screening for individuals with moderate-to-high ISS may improve recovery, reduce complications, and lower the risk of progression to post-traumatic stress disorder.
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M Nadeem Umar
Dept. of Surgery, Islamic International Medical College, Rawalpindi.
