Prevention of post-concussion-like symptoms in emergency room patients: Results from a two-center randomized controlled study comparing an early single-session Eye Movement Desensitization and Reprocessing intervention with usual care

Importance: After a traumatic event, 10 to 20% of injured patients will suffer for several months from various symptoms, collectively termed post-concussion-like symptoms (PCLS), which can lead to a decline in quality of life. Moreover, recent findings suggested that this condition may also apply to patients with an acute medical condition. A preliminary randomized controlled trial suggested that this condition may be prevented by a single early short Eye Movement Desensitization and Reprocessing (EMDR) psychotherapeutic session delivered at the ER. Objective: The present study was designed to compare the impact of the early EMDR intervention versus usual care on 3-month PCLS in patients presenting at the ER. Design, Setting, and Participants: This study was an open-label two-center comparative randomized controlled trial with phone follow-up assessments at 3 months. Eligible participants included adults ( over 18 years old) presenting at the ER who have a high risk of PCLS using a 3-item scoring scale. Interventions: The randomization groups were as follows: (i) EMDR Recent Traumatic Episode Protocol (R-TEP) intervention performed during the ER stay and (ii) usual care. Main Outcomes and Measures: The primary and secondary outcomes were respectively the frequency of PCLS and PTSD at 3 months after the ER visit. Results: This study included 313 patients with a high risk of PCLS who were randomized into two groups; of these patients, 219 were contacted by phone at 3 months. There was no difference in the primary outcome (EMDR: 53.8% vs. Control: 49.6%), but for the secondary outcome, the occurrence of PTSD was greater in the intervention group (9.4% vs. 2.7%, p = 0.04). In the EMDR group, a high level of self-assessed stress at admission (>6) was strongly associated with persistent PCLS (76.9% vs. 40.9%, p = 0.04). Conclusion and Relevance: The present results showed that a single EMDR R-TEP session did not reduce the incidence of PCLS at 3 months in patients admitted to the ER. However, the rate of PTSD was higher in the EMDR group. These results suggest that more data should be collected to define which treatment options may be offered to patients attending the ER and the role that psychologist skill plays in this process. Trial registration: ClinicalTrials.gov identifier [NCT03400813][1]. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT03400813 ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This research project received a positive endorsement from the French Comite de Protection de Personnes (CPP), Ouest II Angers Number RCB = 2017 A01462 51 N CPP = 2017/36. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03400813&atom=%2Fmedrxiv%2Fearly%2F2023%2F05%2F16%2F2023.05.11.23289838.atom