266 Developing a Screening Tool to Assess Acute Stress Disorder in Burn Patients

Acute stress disorder occurs after an individual is exposed to one or more traumatic events. Symptoms can include negative mood, dissociation, avoidance and anxiety/hyperarousal, which can occur from three days to one month post exposure. Acute Stress Disorder (ASD) affects 21–23.6% of adults and is more often diagnosed in women (23%) than men (8%). After being diagnosed with ASD, 57% of men and 92% of women developed post-traumatic stress disorder (PTSD) within six months. Patients with severe burn injuries receive lengthy intensive physical rehabilitation; a focus on the mental health component is often suboptimal. One study showed that 21% of patients presented with symptoms of PTSD. According to the literature, between 30% and 50% of individuals sustaining a burn injury have a pre-existing psychiatric comorbidity making them more vulnerable to self-harm or suicide post burn. Our burn center does not currently have an established process to screen for ASD. A literature search was conducted to gain a detailed understanding of the scope of this problem, and to develop a process that could be easily administered by the nursing staff to provide early intervention. To initially screen patients, the Acute Stress Disorder Scale (ASDS) was selected. The tool is easy to administer and identifies key risk factors of ASD, which include: patients with less than a high school education, ethnic minorities, burn injury, history of domestic violence and previous suicidal ideation. For patients who have a positive ASDS score of 27 or greater, the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS) is administered, and a psychiatric referral is initiated. Although early intervention is best, due to severity of their injuries patients are not screened until they are placed on stepdown protocols. Patients who do not initially receive positive ASDS scores are screened weekly until discharge. Once discharged, patients with positive ASDS scores would be counseled and supplied with a list of psychiatric resources/facilities for follow-up. Early screening post-injury to identify ASD is critical to the management of traumatic stress disorders. Implementing a screening tool for assessment of patients sustaining a burn injury will allow for earlier identification of individuals and allow for earlier interventions. Screening tools when implemented as part of standard nursing practice ensures patients receive physical and mental health assessments, resulting in earlier interventions for a more comprehensive recovery.