Anxiety Disorders: Zatzick DF

Ursano RJ, Bell C, Eth S, Friedman M, Norwood A, Pfefferbaum B, Pynoos JD, Zatzick DF, Benedek DM, McIntyre JS, Charles SC, Altshuler K, Cook I, Cross CD, Mellman L, Moench LA, Norquist G, Twemlow SW, Woods S, Yager J, Anonymous00293, Anonymous00294. · No affiliation provided · Am J Psychiatry. · Pubmed #15617511 No free full text.

This publication has no abstract.

Zatzick DF, Galea S. · Department of Psychiatry & Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98104-2499, USA. · J Trauma Stress. · Pubmed #17721951 No free full text.

Abstract: Early, trauma-focused intervention development has emphasized unidirectional trajectories that begin with basic research and efficacy trials followed later by effectiveness and dissemination studies. In this article, the authors present methods derived from social and clinical epidemiology that constitute foundational research in the development of early trauma-focused intervention. They also describe how population-based practice research may serve to feed back and inform what has been conceptualized as earlier stages of intervention development such as efficacy trials. Examples of relevant epidemiologic research methods are presented to illustrate these points. The authors posit that the continued application of population-based methods may produce treatments that can be feasibly applied to the unique patient, provider, organizational, and community contexts relevant to early interventions for survivors of trauma.

Zatzick DF, Roy-Byrne P, Russo JE, Rivara FP, Koike A, Jurkovich GJ, Katon W. · Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Box 359911, 98104, Seattle, WA, USA. · Gen Hosp Psychiatry. · Pubmed #11427243 No free full text.

Abstract: Posttraumatic behavioral and emotional disturbances occur frequently among physically injured hospitalized trauma survivors. This investigation was a pilot randomized effectiveness trial of a 4-month collaborative care intervention for injured motor vehicle crash and assault victims. As surgical inpatients, intervention subjects (N=16) were assigned to a trauma support specialist who provided counseling, consulted with surgical and primary care providers, and attempted postdischarge care coordination. Control subjects (N=18) received usual posttraumatic care. For all participants, posttraumatic stress disorder (PTSD) and depressive symptoms, episodic alcohol intoxication, and functional limitations were evaluated during the hospitalization and 1 and 4 months postinjury. Study logs and field notes revealed that over 75% of intervention activity occurred in the first month after the trauma. One-month post-trauma intervention subjects when compared to controls demonstrated statistically significant decreases in PTSD symptoms as well as a reduction in depressive symptoms. However, at the 4-month assessment, intervention subjects evidenced no significant improvements in PTSD and depressive symptoms, episodic alcohol intoxication, or functional limitations. Future larger scale trials of stepped collaborative care interventions for physically injured trauma survivors are recommended.

Ghesquiere A, Fan MY, Berliner L, Rivara FP, Jurkovich GJ, Russo J, Katon W, Zatzick DF. · Department of Psychiatry & Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98104-2499, USA. · J Trauma Stress. · Pubmed #18956447 No free full text.

Abstract: Few investigations have simultaneously assessed concordance between youth and parent ratings of posttraumatic stress disorder (PTSD) symptoms and functioning. Randomly sampled adolescent injury survivors ages 12-18 and their parents were assessed on the inpatient ward and again at 2, 5, and 12-months postinjury (N = 99). Adolescent PTSD symptoms and functioning were rated by both adolescents and parents. Parent PTSD was also assessed; 27% of parents endorsed symptoms consistent with a diagnosis of PTSD over the course of the year after adolescent injury. The PTSD positive parents demonstrated significantly greater discordance in ratings of adolescent PTSD symptoms, family cohesion, and mental health functioning. These findings suggest caution in clinical and policy applications of parental ratings of adolescent symptomatic and functional outcomes after injury.

Santos MR, Russo J, Aisenberg G, Uehara E, Ghesquiere A, Zatzick DF. · Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98104, USA. · Psychiatry. · Pubmed #18834274 No free full text.

Abstract: Recent commentary has advocated for epidemiological investigation as a foundational science for understanding disparities in the delivery of mental health care and for the development of early trauma-focused interventions. Few acute care investigations have examined the diversity of ethnic/racial heritages or compared variations in early posttraumatic distress in representative samples of injured trauma survivors. Hospitalized injury survivors at two United States level I trauma centers were randomly approached in order to document linguistic and ethnic/racial diversity. Approximately 12% of patients approached were non-English speaking with 16 languages represented. English speaking, inpatients were screened for posttraumatic stress disorder, peritraumatic dissociative, and depressive symptoms. For 269 English speaking study participants, ethnic/racial group status was clearly categorized into one group for 72%, two groups for 25%, and three groups for 3% of participants. Regression analyses that adjusted for relevant clinical and demographic characteristics revealed that relative to whites, patients from American Indian, African American, Hispanic, and Asian heritages demonstrated significant elevations in one or more posttraumatic symptom clusters. A remarkable diversity of heritages was identified, and posttraumatic distress was elevated in ethnic/racial minority patients. Policy-relevant clinical investigations that combine evidence-based treatments, bilingual/bicultural care-management strategies, and support for trauma center organizational capacity building may be required in order to enhance the quality of mental health care for diverse injured trauma survivors.

Zatzick DF, Jurkovich GJ, Fan MY, Grossman D, Russo J, Katon W, Rivara FP. · Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Campus Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA. · Arch Pediatr Adolesc Med. · Pubmed #18606935 links to  free full text

Abstract: OBJECTIVE: To assess the association between early posttraumatic stress disorder (PTSD) and depressive symptoms and functional and quality-of-life outcomes among injured youth. DESIGN: Prospective cohort study. SETTING: Combined pediatric-adult level I trauma center. PARTICIPANTS: Randomly sampled adolescent injury survivors aged 12 to 18 years (N = 108) were recruited from surgical inpatient units. MAIN EXPOSURES: Posttraumatic stress disorder and depressive symptom levels in the days and weeks immediately following injury. We also collected relevant adolescent demographic, injury, and clinical characteristics. MAIN OUTCOME MEASURE: Multiple domains of adolescent functional impairment were assessed with the 87-item Child Health Questionnaire (CHQ-87) at 2, 5, and 12 months after injury. RESULTS: The investigation attained greater than 80% adolescent follow-up at each assessment after injury. Mixed-model regression was used to assess the association between baseline levels of PTSD and depressive symptoms and subsequent functional outcomes longitudinally. High baseline PTSD symptom levels were associated with significant impairments in CHQ-87 Role/Social Behavioral, Role/Social Physical, Bodily Pain, General Behavior, Mental Health, and General Health Perceptions subscales. High baseline depressive symptoms were associated with significant impairments in CHQ-87 Physical Function, Role/Social Emotional, Bodily Pain, Mental Health, Self-esteem, and Family Cohesion subscales. CONCLUSIONS: Early PTSD and depressive symptoms are associated with a broad spectrum of adolescent functional impairment during the year after physical injury. Coordinated investigative and policy efforts that refine mental health screening and intervention procedures have the potential to improve the functioning and well-being of injured youth treated in the acute care medical setting.

Zatzick DF, Russo J, Rajotte E, Uehara E, Roy-Byrne P, Ghesquiere A, Jurkovich G, Rivara F. · Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359896, HMC 325 Ninth Ave., Seattle, WA 98104, USA. · Psychiatry. · Pubmed #17937531 No free full text.

Abstract: Few investigations have focused on patients' concerns in the immediate aftermath of physical trauma. A population-based sample of 120 hospitalized injury survivors was recruited and followed over the course of the year after injury. Open-ended, semi-structured items were developed to elicit up to three concerns related to the injury from each hospitalized inpatient. Concern narratives were coded into content domains, and concern severity was assessed. Patients most frequently expressed physical health concerns (68%), followed by work and finance (59%), social (44%), psychological (25%), medical (8%), and legal (5%) concerns. The expression of three severe concerns immediately after the trauma was associated with higher PTSD symptoms levels over the course of the year. Greater initial concern severity independently predicted persistent PTSD symptoms 12 months after the injury (Adjusted Relative Risk = 1.71, 95% Confidence Interval = 1.05, 2.78). Early posttraumatic concerns can be readily elicited and reliably interpreted. Psychological concerns constitute a minority of total concerns after physical trauma, and the presence of greater numbers of severe concerns predicts worsening symptomatic course. Incorporation of posttraumatic concern assessments has the potential to simultaneously strengthen the posttraumatic patient-provider relationship and to link patient-centered evaluation with individual and community-level PTSD and functional outcome evaluations.

Zatzick DF, Rivara FP, Nathens AB, Jurkovich GJ, Wang J, Fan MY, Russo J, Salkever DS, Mackenzie EJ. · Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA 98104, USA. · Psychol Med. · Pubmed #17559704 No free full text.

Abstract: BACKGROUND: Injured survivors of individual and mass trauma are at risk for developing post-traumatic stress disorder (PTSD). Few investigations have assessed PTSD after injury in large samples across diverse acute care hospital settings. METHOD: A total of 2931 injured trauma survivors aged 18-84 who were representative of 9983 in-patients were recruited from 69 hospitals across the USA. In-patient medical records were abstracted, and hospitalized patients were interviewed at 3 and 12 months after injury. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist (PCL) 12 months after injury. RESULTS: Approximately 23% of injury survivors had symptoms consistent with a diagnosis of PTSD 12 months after their hospitalization. Greater levels of early post-injury emotional distress and physical pain were associated with an increased risk of symptoms consistent with a PTSD diagnosis. Pre-injury, intensive care unit (ICU) admission [relative risk (RR) 1.17, 95% confidence interval (CI) 1.02-1.34], pre-injury depression (RR 1.33, 95% CI 1.15-1.54), benzodiazepine prescription (RR 1.46, 95% CI 1.17-1.84) and intentional injury (RR 1.32, 95% CI 1.04-1.67) were independently associated with an increased risk of symptoms consistent with a PTSD diagnosis. White injury survivors without insurance demonstrated approximately twice the rate of symptoms consistent with a diagnosis of PTSD when compared to white individuals with private insurance. By contrast, for Hispanic injury survivors PTSD rates were approximately equal between uninsured and privately insured individuals. CONCLUSIONS: Nationwide in the USA, more than 20% of injured trauma survivors have symptoms consistent with a diagnosis of PTSD 12 months after acute care in-patient hospitalization. Coordinated investigative and policy efforts could target mandates for high-quality PTSD screening and intervention in acute care medical settings.

Zatzick DF, Grossman DC, Russo J, Pynoos R, Berliner L, Jurkovich G, Sabin JA, Katon W, Ghesquiere A, McCauley E, Rivara FP. · Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #17003664 No free full text.

Abstract: OBJECTIVE: Adolescents constitute a high-risk population for traumatic physical injury, yet few longitudinal investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms over time in representative samples. METHOD: Between July 2002 and August 2003, 108 randomly selected injured adolescent patients ages 12 to 18 and their parents were interviewed at baseline and again 2, 5, and 12 months postinjury. Initially, participants were screened for PTSD symptoms with the PTSD Reaction Index (PTSD-RI) and depressive symptoms with the Center for Epidemiologic Studies Depression Scale, as well as preinjury trauma. Random-coefficient regression was used to assess the association between baseline clinical, injury, and demographic characteristics and the development and maintenance of PTSD symptoms longitudinally. RESULTS: Between 19% and 32% of adolescents screened positive for PTSD (i.e., had PTSD-RI scores of > or =38) during the course of the 12 months after the injury. Higher initial adolescent PTSD and depressive symptoms, higher emergency department heart rate, greater objective event severity, and greater parental preinjury trauma were significant independent predictors of higher adolescent PTSD symptoms. CONCLUSIONS: For a substantive minority of hospitalized adolescents, high PTSD symptom levels persist during the 12 months after injury. Clinical characteristics readily identifiable after the acute injury predict the development of PTSD symptoms over time. Real-world clinical trials that test screening and intervention procedures for representative samples of at-risk youths are warranted.

Sabin JA, Zatzick DF, Jurkovich G, Rivara FP. · School of Social Work, University of Washington, Seattle, WA 98105-6299, USA. · Pediatrics. · Pubmed #16396870 links to  free full text

Abstract: OBJECTIVE: Few investigations have assessed the primary care detection of adolescent posttraumatic emotional distress after an injury. We aimed to determine (1) the level of attachment to primary care providers (PCPs) and school providers among this group of high-risk adolescents, (2) the emotional status of this population postinjury, (3) continuity of care between trauma center and community care, and (4) PCPs' detection of emotional problems in adolescents after an injury. METHODS: This was a prospective cohort study of traumatically injured adolescents aged 12 to 18 who were admitted to a level I regional trauma center. Adolescents were screened for posttraumatic stress symptoms, depressive symptoms, and alcohol use on the surgical ward and 4 to 6 months postinjury. PCPs were contacted by telephone 4 to 6 months postinjury to assess follow-up care and the detection of emotional distress. RESULTS: In the surgical ward, 39.4% of the adolescent patients or their parents reported no identifiable source of regular medical care. Only 24.3% of the patients had visited a PCP during the 4 to 6 months after injury. At 4 to 6 months postinjury, 30% of the adolescents were experiencing high posttraumatic stress symptom levels, 11% were experiencing high depressive symptom levels, and 17% had high levels of alcohol use. PCPs did not detect any new emotional distress or problem drinking during postinjury office visits. CONCLUSIONS: Injured adolescents represent a high-risk pediatric population, a substantial number of whom develop mental health problems postinjury. Furthermore, almost 40% of adolescents in our study reported no source of primary care. These results suggest that referrals from trauma centers to PCPs are necessary and that an increase in awareness of and screening for adolescent emotional distress postinjury during follow-up appointments and at school should be routine components of postinjury care.

Sabin JA, Zatzick DF, Rivara FP. · School of Social Work, University of Washington, 4101 15th Ave, NE, Seattle, WA 98105, USA. · J Sch Health. · Pubmed #15988840 No free full text.

This publication has no abstract.

Zatzick DF, Russo J, Pitman RK, Rivara F, Jurkovich G, Roy-Byrne P. · Department of Psychiatry, Harborview Medical Center, University of Washington School of Medicine, Box 359911, HMC, 325 Ninth Avenue, Seattle, WA 98104, USA. · Biol Psychiatry. · Pubmed #15607305 No free full text.

Abstract: BACKGROUND: Preliminary investigations in select samples of trauma survivors presenting to acute care settings suggest an association between elevated emergency department heart rate (HR) and the subsequent development of posttraumatic stress disorder (PTSD). Other studies suggest no association, however. METHOD: In a prospective cohort study of a population-based sample of 161 acutely injured surgical inpatients, HR was assessed at initial presentation to the emergency department. Symptoms of PTSD were assessed with the PTSD Checklist at the time of the surgical inpatient hospitalization and 1, 4-6, and 12 months postinjury. RESULTS: Emergency department HR > or = 95 beats per minute (BPM) was a significant independent predictor of PTSD symptoms in analyses that adjusted for relevant injury, clinical, and demographic characteristics. This HR cutoff demonstrated modest specificity (range 60%-65%) and sensitivity (range 49%-63%) for the prediction of chronic PTSD. CONCLUSIONS: We found an independent association between elevated emergency department HR > or = 95 BPM and PTSD symptoms in a representative sample of injured acute care inpatients. Future investigations that incorporate clinical epidemiologic methods in the study of acute care biological parameters have the potential to improve the quality of mental health care delivered to injured survivors of individual and mass trauma.

Zatzick DF, Russo JE, Katon W. · Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle 98104-2499, USA. · Psychosomatics. · Pubmed #14597682 links to  free full text

Abstract: Few investigations have examined the course of somatic complaints among acutely injured trauma survivors. Posttraumatic stress disorder (PTSD), depressive, and somatic symptoms were assessed in trauma surgery inpatients (N=73) interviewed while hospitalized and again 12 months after their injury. Somatic symptoms occurred frequently and were significantly greater in patients with higher levels of PTSD and depressive symptoms, even after the analyses were adjusted for injury severity and medical comorbidity. These findings, when considered in conjunction with data documenting the heterogeneity of treatment providers visited after traumatic injury, suggest that the development of early screening and intervention procedures should incorporate assessments of physical symptoms.

Zatzick DF, Kang SM, Müller HG, Russo JE, Rivara FP, Katon W, Jurkovich GJ, Roy-Byrne P. · Department of Psychiatry, University of California-Davis, USA. · Am J Psychiatry. · Pubmed #12042181 links to  free full text

Abstract: OBJECTIVE: Each year approximately 2.5 million Americans are hospitalized after sustaining traumatic physical injuries. Few investigations have comprehensively screened for posttraumatic symptomatic distress or identified predictors of posttraumatic stress disorder (PTSD) in representative samples of surgical inpatients. METHOD: The subjects were 101 randomly selected survivors of motor vehicle crashes or assaults who were interviewed while hospitalized and 1, 4, and 12 months after injury. In the surgical ward, inpatients were screened for PTSD, depressive, and dissociative symptoms, for prior trauma, for pre-event functioning, and for alcohol and drug intoxication. Patient demographic and injury characteristics were also recorded. Random coefficient regression models were used to assess the association between these clinical, injury, and demographic characteristics and PTSD symptom levels over the year after the injury. RESULTS: Of the 101 surgical inpatients, 73% screened positive for high levels of symptomatic distress and/or substance intoxication. At 1, 4, and 12 months after the injury, 30%-40% reported symptoms consistent with a diagnosis of PTSD. High ward PTSD symptom levels were the strongest and most parsimonious predictor of persistent symptoms over the course of the year. Greater prior trauma, stimulant intoxication, and female gender were also associated with higher symptom levels. Increasing injury severity, however, was not associated with higher PTSD symptom levels. CONCLUSIONS: Clinical and demographic characteristics readily identifiable at the time of surgical inpatient hospitalization predict PTSD symptoms over the year after injury. Effectiveness trials that test screening and intervention procedures for at-risk inpatients should be developed.

Zatzick DF, Jurkovich GJ, Gentilello L, Wisner D, Rivara FP. · Harborview Injury Prevention and Research Center and Department of Psychiatry, University of Washington School of Medicine, Seattle, WA 98104-2499. · Arch Surg. · Pubmed #11822960 links to  free full text

Abstract: HYPOTHESIS: Patients undergoing trauma surgery for injury who have subsequent posttraumatic stress disorder (PTSD) or problem drinking will demonstrate significant impairments in functional outcomes compared with patients without these disorders. DESIGN: Prospective cohort study. SETTING: Level I academic trauma center. PARTICIPANTS: One hundred one randomly selected survivors of intentional and unintentional injuries were interviewed while hospitalized and again 1 year later. The investigation achieved a 73% 1-year follow-up rate. MAIN OUTCOME MEASURES: Posttraumatic stress disorder was assessed with the Post-traumatic Stress Disorder Checklist and problem drinking was assessed with the Alcohol Use Disorder Identification Test. Functional status was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS: One year after injury, 30% of patients (n = 22) met symptomatic criteria for PTSD and 25% (n = 18) had Alcohol Use Disorder Identification Test scores indicative of problem drinking. Patients with PTSD demonstrated significant adverse outcomes in 7 of the 8 domains of the Medical Outcomes Study 36-Item Short-Form Health Survey compared with patients without PTSD. In multivariate models that adjusted for injury severity, chronic medical conditions, age, sex, preinjury physical function, and alcohol use, PTSD remained the strongest predictor of an adverse outcome. Patients with problem drinking did not demonstrate clinically or statistically significant functional impairment compared with patients without problem drinking. CONCLUSIONS: Posttraumatic stress disorder persisted in 30% of patients 1 year after traumatic injury and was independently associated with a broad profile of functional impairment. The development of treatment intervention protocols for trauma patients with PTSD is warranted.

Zatzick DF, Kang SM, Hinton WL, Kelly RH, Hilty DM, Franz CE, Le L, Kravitz RL. · Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, 98104-2499, USA. · Med Care. · Pubmed #11329520 No free full text.

Abstract: BACKGROUND: Approximately 2.5 million Americans are admitted to the hospital after traumatic physical injury each year. Few investigations have elicited patients' perspectives regarding posttraumatic outcomes. OBJECTIVE: To identify and categorize physically injured trauma survivors' posttraumatic concerns. RESEARCH DESIGN: Prospective longitudinal investigation; trauma survivors were interviewed during the post-injury hospitalization and again 1, 4, and 12 months after the trauma. SUBJECTS: Ninety-seven, randomly selected, English speaking, hospitalized survivors of motor vehicle-crashes or assaults. MEASURES: At the end of each interview patients were asked, "Of all the things that have happened to you since you were injured, what concerns you the most?" Using an iterative process and working by consensus, investigators categorized patient concerns in content domains. Concern domains were then compared with established measures of posttraumatic stress disorder (PTSD) symptoms and limitations in physical functioning. RESULTS: Seven categories of posttraumatic concerns were identified. During the course of the year, 73% of patients expressed physical health concerns, 58% psychological concerns, 53% work and finance concerns, 40% social concerns, 10% legal concerns, 10% medical concerns, and 20% uncodable concerns. Rater agreement on concern categorization was substantial (kappa = 0.72). The mean number of concerns expressed per patient gradually decreased over time (1 month mean = 1.51; 12 month mean = 1.26) and resembled the trajectories of PTSD symptoms and functional limitations. CONCLUSIONS: The concerns of physically injured trauma survivors are readily elicited and followed up during the course of the year after injury. Open-ended inquiry regarding posttraumatic concerns may complement standardized outcome assessments by identifying and contextualizing the outcomes of greatest importance to patients.

Zatzick DF, Kang SM, Kim SY, Leigh P, Kravitz R, Drake C, Sue S, Wisner D. · Department of Psychiatry, University of California at Davis, Sacramento, USA. · J Trauma. · Pubmed #11003328 No free full text.

Abstract: BACKGROUND: Although psychiatric disturbances are highly prevalent among traumatically injured inpatients, few investigations have assessed the impact of these disorders on surgical length of stay (LOS) and cost. METHODS: The authors identified all trauma-registry recorded psychiatric diagnoses among patients admitted to University of California Davis Medical Center between January 1993 and December 1996. Linear and logistic regressions were used to assess the unique effects of psychiatric diagnoses on inpatient LOS and cost. RESULTS: A total of 29% of patients had one or more registry-recorded psychiatric diagnosis. Patients with alcohol abuse diagnoses demonstrated 10% to 12% decreases in LOS and cost (p < 0.01), whereas patients with stress disorders, delirium, and psychoses demonstrated 46% to 103% increases in LOS and cost (p < 0.01). CONCLUSION: Patients with recognized psychiatric disorders uniquely impact inpatient trauma surgery LOS and cost. Additional investigations of the processes and outcomes of care could lead to cost-effective performance improvement efforts that target the amelioration of comorbid psychiatric disorders among physically injured trauma survivors.

Ruzek JI, Zatzick DF. · National Center for PTSD, Education Division, VA Palo Alto Health Care System, Palo Alto, CA, USA. · Gen Hosp Psychiatry. · Pubmed #10715501 No free full text.

Abstract: Posttraumatic behavioral and emotional disturbances occur frequently among physically injured trauma survivors. Despite increasing investigative interest in the evaluation and treatment of psychological distress in acutely injured patients, few studies have assessed ethical considerations surrounding research participation. The authors empirically investigated ethical considerations in research participation among 117 physically injured, hospitalized, motor vehicle accident and assault survivors. Immediately following a 1-hour research interview, participants responded to 10 questions assessing the experience of research participation. The majority of study subjects found participating in the protocol a positive experience. Most of the hospitalized patients reported that they experienced control over initiation and discontinuation of the protocol and that they derived benefit from their research participation. A minority of participants reported that they experienced unwanted thoughts and unanticipated upset during the protocol and that they felt they could not refuse participation. However, over 95% of patients reported that the benefits of protocol participation outweighed the costs and that in retrospect they would again agree to participate. These results suggest that while a minority of participants may have difficulties with specific aspects of protocol enrollment, overall research participation is well tolerated by the majority of acutely injured, hospitalized, trauma survivors.