{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:26:59Z","timestamp":1787009219651,"version":"build-2736575974"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"Supplement_6","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Posttraumatic stress disorder (PTSD) is prevalent among military personnel and may arise following a wide range of traumatic exposures. Consciousness level following traumatic injury may play a role in the development of PTSD, but its effects have been primarily investigated in the context of traumatic brain injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Registry-based study surveying three databases documenting care from point of injury to long-term rehabilitation of traumatic injuries among military personnel. The study population was divided according to Glasgow Coma Scale (GCS) scores upon emergency department admission (GCS scores 15, 13 and 14, 9\u201312, and 3\u20138), with PTSD diagnoses being determined according to disability claim records. Multivariable logistic regression was utilized to determine the association between GCS score at admission and PTSD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 3,376 military personnel hospitalized following traumatic injuries between 1997 and 2020 were included. The majority were male (92.3%), with a median age of 20 (interquartile range 19\u201322) at the injury time. Of these, 569 (16.9%) were diagnosed with PTSD according to disability claims, with a median follow-up time of 10.9\u2009years. PTSD diagnosis was most prevalent (30.3% of patients), with a GCS score of 13 and 14. In the adjusted multivariable model, a GCS score of 13 and 14 was associated with significantly higher odds of PTSD diagnosis when compared to a GCS score of 15 (odds ratio 2.19, 95% CI, 1.21\u20133.88). The associations of other GCS groupings with PTSD diagnosis were nonsignificant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Minimally impaired consciousness following traumatic injuries is associated with increased odds of PTSD. The role of patient awareness, analgesia, and sedation following an injury in developing PTSD warrants further investigation and could guide early diagnosis and preventive interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usad180","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T02:55:37Z","timestamp":1686192937000},"page":"428-435","source":"Crossref","is-referenced-by-count":5,"title":["The Association Between Glasgow Coma Scale Scores and PTSD in Military Trauma Casualties: Does Mental Status Following Injury Play a Role in PTSD Development?"],"prefix":"10.1093","volume":"188","author":[{"given":"Shir","family":"Bulis","sequence":"first","affiliation":[{"name":"Israel Defense Forces Medical Corps, Surgeon General\u2019s Headquarters, Israel Defense Forces , Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7440-8864","authenticated-orcid":false,"given":"Tomer","family":"Talmy","sequence":"additional","affiliation":[{"name":"Israel Defense Forces Medical Corps, Surgeon General\u2019s Headquarters, Israel Defense Forces , Ramat Gan 5262000, Israel"},{"name":"Department of Military Medicine, Faculty of Medicine, Hebrew University , Jerusalem 9574869, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6799-0633","authenticated-orcid":false,"given":"Irina","family":"Radomislensky","sequence":"additional","affiliation":[{"name":"The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center , Tel-HaShomer 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Gelman","sequence":"additional","affiliation":[{"name":"Israel Defense Forces Medical Corps, Surgeon General\u2019s Headquarters, Israel Defense Forces , Ramat Gan 5262000, Israel"},{"name":"Department of Military Medicine, Faculty of Medicine, Hebrew University , Jerusalem 9574869, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shir","family":"Bushinsky","sequence":"additional","affiliation":[{"name":"Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem , Jerusalem 91905, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dikla","family":"Nachum","sequence":"additional","affiliation":[{"name":"Israel Defense Forces Medical Corps, Surgeon General\u2019s Headquarters, Israel Defense Forces , Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Tomer","sequence":"additional","affiliation":[{"name":"Israel Defense Forces Medical Corps, Surgeon General\u2019s Headquarters, Israel Defense Forces , Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1564-6395","authenticated-orcid":false,"given":"Avishai M","family":"Tsur","sequence":"additional","affiliation":[{"name":"Israel Defense Forces Medical Corps, Surgeon General\u2019s Headquarters, Israel Defense Forces , Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer","family":"Paulman","sequence":"additional","affiliation":[{"name":"Israel Defense Forces Medical Corps, Surgeon General\u2019s Headquarters, Israel Defense Forces , Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2772-9550","authenticated-orcid":false,"given":"Sami","family":"Gendler","sequence":"additional","affiliation":[{"name":"Israel Defense Forces Medical Corps, Surgeon General\u2019s Headquarters, Israel Defense Forces , Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0293-681X","authenticated-orcid":false,"given":"Ofer","family":"Almog","sequence":"additional","affiliation":[{"name":"Israel Defense Forces Medical Corps, Surgeon General\u2019s Headquarters, Israel Defense Forces , Ramat Gan 5262000, Israel"},{"name":"Department of Military Medicine, Faculty of Medicine, Hebrew University , Jerusalem 9574869, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1901-9038","authenticated-orcid":false,"given":"Avi","family":"Benov","sequence":"additional","affiliation":[{"name":"Israel Defense Forces Medical Corps, Surgeon General\u2019s Headquarters, Israel Defense Forces , Ramat Gan 5262000, Israel"},{"name":"The Azrieli Faculty of Medicine, Bar-Ilan University , Safed 1311502, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,8]]},"reference":[{"issue":"3","key":"2023111015081112000_R1","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1002\/jts.20406","article-title":"A comparison of PTSD symptom patterns in three types of civilian trauma","volume":"22","author":"Kelley","year":"2009","journal-title":"J Trauma Stress"},{"key":"2023111015081112000_R2","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.janxdis.2016.01.007","article-title":"Is worst-event trauma type related to PTSD symptom presentation and associated features?","volume":"38","author":"Smith","year":"2016","journal-title":"J Anxiety Disord"},{"issue":"1","key":"2023111015081112000_R3","doi-asserted-by":"publisher","first-page":"E21","DOI":"10.1097\/HTR.0000000000000514","article-title":"A systematic review and meta-analysis on PTSD following TBI among military\/veteran and civilian populations","volume":"35","author":"Loignon","year":"2020","journal-title":"J Head Trauma Rehabil"},{"issue":"2","key":"2023111015081112000_R4","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1097\/NMD.0000000000000581","article-title":"The impact of trauma type or number of traumatic events on PTSD diagnosis and symptom severity in treatment seeking veterans","volume":"205","author":"Jakob","year":"2017","journal-title":"J Nerv Ment Dis"},{"key":"2023111015081112000_R5","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.neubiorev.2019.09.013","article-title":"Risk factors for posttraumatic stress disorder: an umbrella review of systematic reviews and meta-analyses","volume":"107","author":"Tortella-Feliu","year":"2019","journal-title":"Neurosci Biobehav Rev"},{"issue":"8","key":"2023111015081112000_R6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11920-015-0612-y","article-title":"Risk factors for the development of psychopathology following trauma","volume":"17","author":"Sayed","year":"2015","journal-title":"Curr Psychiatry Rep"},{"issue":"3","key":"2023111015081112000_R7","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1001\/jamapsychiatry.2018.4288","article-title":"Risk of posttraumatic stress disorder and major depression in civilian patients after mild traumatic brain injury: a track-TBI study","volume":"76","author":"Stein","year":"2019","journal-title":"JAMA Psychiatry"},{"issue":"12","key":"2023111015081112000_R8","doi-asserted-by":"publisher","first-page":"2151","DOI":"10.1080\/03007995.2021.1978417","article-title":"Prevalence of post-traumatic stress disorder in the United States: a systematic literature review","volume":"37","author":"Schein","year":"2021","journal-title":"Curr Med Res Opin"},{"issue":"7","key":"2023111015081112000_R9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-006303","article-title":"Global burden of post-traumatic stress disorder and major depression in countries affected by war between 1989 and 2019: a systematic review and meta-analysis","volume":"6","author":"Hoppen","year":"2021","journal-title":"BMJ Glob Health"},{"key":"2023111015081112000_R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2020.113242","article-title":"PTSD and obesity in U.S. military veterans: prevalence, health burden, and suicidality","volume":"291","author":"Stefanovics","year":"2020","journal-title":"Psychiatry Res"},{"key":"2023111015081112000_R11","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1007\/978-0-387-78665-0_89","volume-title":"Handbook of Disease Burdens and Quality of Life Measures","author":"Freed","year":"2010"},{"issue":"1","key":"2023111015081112000_R12","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1097\/00005373-199401000-00014","article-title":"Problems with initial Glasgow Coma Scale assessment caused by prehospital treatment of patients with head injuries: results of a national survey","volume":"36","author":"Marion","year":"1994","journal-title":"J Trauma"},{"key":"2023111015081112000_R13","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-4-5","article-title":"Posttraumatic stress disorder in patients with traumatic brain injury","volume":"4","author":"Glaesser","year":"2004","journal-title":"BMC Psychiatry"},{"issue":"2","key":"2023111015081112000_R14","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1002\/jts.21909","article-title":"Glasgow Coma Scores, early opioids, and posttraumatic stress disorder among combat amputees","volume":"27","author":"Melcer","year":"2014","journal-title":"J Trauma Stress"},{"issue":"2","key":"2023111015081112000_R15","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1176\/appi.neuropsych.17090180","article-title":"Traumatic brain injury and posttraumatic stress disorder: conceptual, diagnostic, and therapeutic considerations in the context of co-occurrence","volume":"30","author":"Vasterling","year":"2018","journal-title":"J Neuropsychiatry Clin Neurosci"},{"issue":"4","key":"2023111015081112000_R16","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1176\/appi.ajp.157.4.629","article-title":"Posttraumatic stress disorder after severe traumatic brain injury","volume":"157","author":"Bryant","year":"2000","journal-title":"Am J Psychiatry"},{"issue":"5","key":"2023111015081112000_R17","doi-asserted-by":"publisher","first-page":"245","DOI":"10.5435\/00124635-201105000-00001","article-title":"Posttraumatic stress disorders in civilian orthopaedics","volume":"19","author":"Aaron","year":"2011","journal-title":"J Am Acad Orthop Surg"},{"issue":"12","key":"2023111015081112000_R18","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"12","author":"von Elm","year":"2014","journal-title":"Int J Surg"},{"issue":"2S Suppl 2","key":"2023111015081112000_R19","doi-asserted-by":"publisher","first-page":"S32","DOI":"10.1097\/TA.0000000000002776","article-title":"The Israel Defense Forces Trauma Registry: 22 years of point-of-injury data","volume":"89","author":"Tsur","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"issue":"10","key":"2023111015081112000_R20","doi-asserted-by":"publisher","first-page":"3416","DOI":"10.1016\/j.injury.2022.08.053","article-title":"Femur fractures and hemorrhagic shock: implications for point of injury treatment","volume":"53","author":"Mitchnik","year":"2022","journal-title":"Injury"},{"issue":"12","key":"2023111015081112000_R21","doi-asserted-by":"publisher","first-page":"2174","DOI":"10.1007\/s00586-011-1866-7","article-title":"Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study","volume":"20","author":"Hasler","year":"2011","journal-title":"Eur Spine J"},{"issue":"8","key":"2023111015081112000_R22","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/S2352-4642(19)30194-4","article-title":"Characterisation of serum total tau following paediatric traumatic brain injury: a case-control study","volume":"3","author":"Stukas","year":"2019","journal-title":"Lancet Child Adolesc Health"},{"issue":"1","key":"2023111015081112000_R23","article-title":"Characteristics of patients with an abnormal Glasgow Coma Scale Score in the prehospital setting","volume":"12","author":"Durant","year":"2011","journal-title":"West J Emerg Med"},{"issue":"6","key":"2023111015081112000_R24","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1016\/j.janxdis.2011.03.016","article-title":"The challenge of estimating PTSD prevalence in the context of ongoing trauma: the example of Israel during the Second Intifada","volume":"25","author":"Hoffman","year":"2011","journal-title":"J Anxiety Disord"},{"issue":"12","key":"2023111015081112000_R25","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.4088\/JCP.14m09328","article-title":"Posttraumatic stress disorder in the US veteran population: results from the National Health and Resilience in Veterans Study","volume":"75","author":"Wisco","year":"2014","journal-title":"J Clin Psychiatry"},{"issue":"11","key":"2023111015081112000_R26","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1002\/da.20730","article-title":"Gender differences in depression and PTSD symptoms following combat exposure","volume":"27","author":"Luxton","year":"2010","journal-title":"Depress Anxiety"},{"issue":"8","key":"2023111015081112000_R27","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1016\/S1474-4422(14)70120-6","article-title":"The Glasgow Coma Scale at 40 years: standing the test of time","volume":"13","author":"Teasdale","year":"2014","journal-title":"Lancet Neurol"},{"issue":"4","key":"2023111015081112000_R28","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1089\/neu.2010.1433","article-title":"Diagnostic value of the Glasgow Coma Scale for traumatic brain injury in 18,002 patients with severe multiple injuries","volume":"28","author":"Grote","year":"2011","journal-title":"J Neurotrauma"},{"issue":"5","key":"2023111015081112000_R29","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1056\/NEJMoa072972","article-title":"Mild traumatic brain injury in U.S. soldiers returning from Iraq","volume":"358","author":"Hoge","year":"2008","journal-title":"N Engl J Med"},{"issue":"1","key":"2023111015081112000_R30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/HTR.0b013e3181c2993d","article-title":"Prevalence and psychological correlates of traumatic brain injury in operation Iraqi Freedom","volume":"25","author":"MacGregor","year":"2010","journal-title":"J Head Trauma Rehabil"},{"issue":"12","key":"2023111015081112000_R31","doi-asserted-by":"publisher","first-page":"1446","DOI":"10.1093\/aje\/kwn068","article-title":"Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: persistent postconcussive symptoms and posttraumatic stress disorder","volume":"167","author":"Schneiderman","year":"2008","journal-title":"Am J Epidemiol"},{"issue":"1","key":"2023111015081112000_R32","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1089\/neu.2013.2984","article-title":"Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study","volume":"31","author":"McMahon","year":"2014","journal-title":"J Neurotrauma"},{"issue":"23","key":"2023111015081112000_R33","doi-asserted-by":"publisher","first-page":"2233","DOI":"10.1056\/NEJMe2204710","article-title":"PTSD\u2014seeking the ghost in the machine","volume":"386","author":"Folkerth","year":"2022","journal-title":"N Engl J Med"},{"issue":"5","key":"2023111015081112000_R34","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1176\/appi.ajp.162.5.963","article-title":"Does memory of a traumatic event increase the risk for posttraumatic stress disorder in patients with traumatic brain injury? A prospective study","volume":"162","author":"Gil","year":"2005","journal-title":"Am J Psychiatry"},{"issue":"1","key":"2023111015081112000_R35","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1177\/070674370304800106","article-title":"The relation between memory of the traumatic event and PTSD: evidence from studies of traumatic brain injury","volume":"48","author":"Klein","year":"2003","journal-title":"Can J Psychiatry"},{"issue":"2 Suppl","key":"2023111015081112000_R36","doi-asserted-by":"publisher","first-page":"S178","DOI":"10.1097\/TA.0b013e318299d650","article-title":"Prehospital intubation success rates among Israel Defense Forces providers: epidemiologic analysis and effect on doctrine","volume":"75","author":"Katzenell","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"issue":"2","key":"2023111015081112000_R37","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1213\/ANE.0000000000004327","article-title":"Ketamine administration during hospitalization is not associated with posttraumatic stress disorder outcomes in military combat casualties: a matched cohort study","volume":"130","author":"Highland","year":"2020","journal-title":"Anesth Analg"},{"issue":"2 Suppl","key":"2023111015081112000_R38","doi-asserted-by":"publisher","first-page":"S195","DOI":"10.1097\/TA.0b013e318160ba1","article-title":"The correlation between ketamine and posttraumatic stress disorder in burned service members","volume":"64","author":"McGhee","year":"2008","journal-title":"J Trauma"},{"issue":"4","key":"2023111015081112000_R39","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1007\/s40719-020-00199-2","article-title":"Prehospital analgesia and sedation: a perspective from the battlefield","volume":"6","author":"Fisher","year":"2020","journal-title":"Curr Trauma Rep"},{"issue":"2S Suppl 1","key":"2023111015081112000_R40","doi-asserted-by":"publisher","first-page":"S71","DOI":"10.1097\/TA.0000000000003695","article-title":"Opioid sparing effect of ketamine in military pre-hospital pain management \u2013 a retrospective study","volume":"93","author":"Cohen","year":"2022","journal-title":"J Trauma Acute Care Surg"},{"key":"2023111015081112000_R41","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1056\/NEJMoa0903326","article-title":"Morphine Use after Combat Injury in Iraq and Post-Traumatic Stress Disorder","volume":"362","author":"Holbrook","year":"2010","journal-title":"N Engl J Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/Supplement_6\/428\/53074599\/usad180.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/Supplement_6\/428\/53074599\/usad180.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T10:08:27Z","timestamp":1699610907000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/188\/Supplement_6\/428\/7388167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":41,"journal-issue":{"issue":"Supplement_6","published-online":{"date-parts":[[2023,11,8]]},"published-print":{"date-parts":[[2023,11,8]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usad180","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11,1]]},"published":{"date-parts":[[2023,11,1]]}}}