A retrospective study of ketamine administration and the development of acute or post‐traumatic stress disorder in 274 war‐wounded soldiers

Summary & key facts

Researchers looked back at medical records of soldiers wounded in Afghanistan to see if giving ketamine during emergency care changed the chance of later developing post-traumatic stress disorder (PTSD). They studied about 274 injured soldiers who survived and were checked by a psychiatrist for PTSD. More people with PTSD had received ketamine than people without PTSD, but those who got ketamine were also more badly injured. After adjusting for other factors, ketamine was not linked to a higher risk of PTSD. This study suggests that using ketamine in battlefield or emergency care was not shown to cause PTSD, but because the study only looked back at records and the ketamine group was sicker, it cannot prove ketamine is safe or protective for mental health.

Key facts:

• The researchers reviewed records of soldiers wounded in Afghanistan between 2010 and 2012 and analyzed about 274 survivors who had psychiatric assessments.
• About 36% of the 274 soldiers were diagnosed with PTSD by a psychiatrist.
• About 32% of the soldiers received ketamine during their care.
• In the raw numbers, roughly 55% of those who developed PTSD had received ketamine, compared with about 20% of those who did not develop PTSD.
• Soldiers who received ketamine tended to be more severely injured than those who did not, which can affect later mental health.
• When the researchers adjusted for other factors at the same time, only having an acute stress reaction soon after injury and having more surgical operations were linked to later PTSD; ketamine itself was not an independent risk factor in this analysis.
• Because this was a retrospective study that looked back at existing records, it cannot prove cause and effect and may miss other important differences between patients.

Abstract

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.

Topics

Anesthesia and Neurotoxicity Research Posttraumatic Stress Disorder Research Treatment of Major Depression

Categories

Health Sciences Medicine Pharmacology

Tags

Acute Stress Disorder Anesthesia Anxiety Glasgow Coma Scale Internal medicine Ketamine Logistic regression Medicine Psychiatry Retrospective cohort study Traumatic stress

Substances

Ketamine

Conditions & symptoms

Anxiety Chronic pain