Predictive Factors for Development of Post-Traumatic Stress Disorder in Adult Burn Injuries

Dr Tim Wang1, Dr Bish Soliman, Prof Caryl Barnes, Dr  Shane O’Neill, Dr Jeon Cha

1Royal North Shore Hospital Sydney – Severe Burns Unit, Sydney, Australia


Post-traumatic stress disorder (PTSD) is seen in up to 33% of adult patients with severe burn injuries.1 Diagnostic criteria for PTSD includes avoidance, painful re-experiences of stressors, emotional withdrawal and hyperarousal for more than 4 weeks or an acute stress disorder lasting more than 3 months.2 Signs of PTSD can occur up to 2 years later with the majority of affected patients not seeking assistance.1 3 This adversely affects the patient’s rehabilitation, quality of life and integration back into society.3 Understanding the predictive risk factors for development of PTSD is the first step in identifying patients most at risk.

Method: A systematic review was conducted across Google Scholar, Medline, EMBASE databases on predictive factors associated with PTSD in adult burns patients.

Results: Young age, concern of scarring, introversion, avoidant behaviour and anxiety disorders are associated with increased risk of PTSD.1 3 Size of total body surface area (TBSA) is a variable predictor with six out of 9 articles finding no association between %TBSA and development of PTSD.1-9 Mechanism, length of stay and gender is equally controversial with a proportion of studies associating female gender and victims of flame/explosive mechanism with development of PTSD. Extroversion, social support and psychological resilience have a protective effect.6 7

Conclusion: Early detection and management of PTSD is critical in effective rehabilitation of burns patients. Personality, subjective interpretation of stressors and social support have a significant role in mediating development of PTSD. Guideline on its prevention, screening and management in burns injury is yet to be formalised but should extend to >12 months post injury to capture those most at risk.


Dr Tim Wang is a post-fellowship senior registrar in Plastic Surgery at Royal North Shore Hospital with an interest in microsurgery, hand surgery and burns.
Raised in Scandinavia, Tim obtained his medical degree from Imperial College London, preceptorship in plastic surgery at Harvard University Beth Israel Deaconess Medical Centre and a Masters in plastic surgery from the University of Sydney. Outside of work he enjoys wrestling two young children, swimming, travel and photography.
Tim’s main aim is to use research as a means to optimise current clinical practice and improve patient care.

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