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 for soldiers who survived war injuries in Afghanistan from 2010 to 2012 to see if giving ketamine during their care affected later development of post‑traumatic stress disorder, or PTSD. They analysed 274 survivors. At first glance, more people with PTSD had received ketamine than those without PTSD. But people who got ketamine also had worse injuries and more surgeries. After the researchers adjusted for those and other factors, ketamine was not linked to a higher chance of developing PTSD. This was a retrospective study, so it can’t prove what caused what.

Key facts:

• The study used past medical records of soldiers injured in Afghanistan between 2010 and 2012 and analysed 274 survivors.
• About 36% of those 274 soldiers were later diagnosed with PTSD by a psychiatrist.
• About 32% of the 274 soldiers received ketamine during their care.
• In the raw numbers, about 55% of the soldiers with PTSD had received ketamine, compared with about 20% of those without PTSD.
• Soldiers who received ketamine tended to have more severe injuries and more surgeries, which could affect PTSD risk.
• When the researchers adjusted for other factors, only having acute stress disorder early on and the total number of surgeries were independently linked to later PTSD; ketamine was not.
• Because this was a retrospective observational study, it can show associations but cannot prove that ketamine did or did not cause PTSD.

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