The Psychological Impact of Adult Traumatic Brachial Plexus Injury

Abstract

Background:

Adult traumatic brachial plexus injuries (BPIs) present a significant medical challenge, potentially leading to life-altering consequences for patients’ upper extremity pain and function. However, the psychological impact on patients has not been extensively studied.

Methods:

Adult patients with traumatic BPIs treated at 2 tertiary referral centers in the United States from 2015 to 2019 were retrospectively identified. This cohort of 84 patients was targeted for prospective interviews, and 44 patients (52%) responded. Validated measures including the posttrumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (PCL-5), Decision Regret Scale, Patient-Reported Outcome Measurement Information System (PROMIS) Pain Intensity, PROMIS Pain Interference, PROMIS Upper Extremity, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) were obtained through telephone-based interviews. Additional data were collected through electronic medical record review.

Results:

On average, patients experience low post-traumatic stress (median score 6, interquartile range [IQR] 3-20) and decision regret (median score 5, IQR 0-22.5). However, a notable fraction (18%) of patients met the clinical threshold for PTSD. Significant correlations were observed between PCL-5 scores and worse PROMIS Pain Intensity, PROMIS Pain Interference, PROMIS Upper Extremity, and QuickDASH. Decision regret scores correlated with worse PROMIS Upper Extremity and QuickDASH.

Conclusions:

While the overall incidence of PTSD and treatment decision regret after adult traumatic BPI is low, clinical PTSD was found in a significant percentage of patients associated with pain and functional impairment. This study highlights the importance of understanding and addressing the psychological burden of traumatic BPI.