1. This article and any supplementary material should be cited as follows: Melcer T, Walker J, Bhatnagar V, Richard E, Han P, Sechriest VF 2nd, Lebedda M, Quinn K, Galarneau M. Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees. J Rehabil Res Dev. 2014;51(5):697–710. http://dx.doi.org/10.1682/JRRD.2013.06.0143 Slideshow Project DOI:10.1682/JRRD.2013.06.0143JSP Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees Ted Melcer, PhD; Jay Walker, BA; Vibha Bhatnagar, MD; Erin Richard, MPH; Peggy Han, MPH; V. Franklin Sechriest II, MD; Martin Lebedda, RN; Kimberly Quinn, RN; Michael Galarneau, MS, NREMT

2. This article and any supplementary material should be cited as follows: Melcer T, Walker J, Bhatnagar V, Richard E, Han P, Sechriest VF 2nd, Lebedda M, Quinn K, Galarneau M. Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees. J Rehabil Res Dev. 2014;51(5):697–710. http://dx.doi.org/10.1682/JRRD.2013.06.0143 Slideshow Project DOI:10.1682/JRRD.2013.06.0143JSP Aim – Use military and VA health data to investigate effect of early postinjury medications on 4 yr psychological outcomes of combat amputees. Relevance – Morphine and fentanyl are frequently used for analgesia after trauma, but their advantages and disadvantages are debated.

3. This article and any supplementary material should be cited as follows: Melcer T, Walker J, Bhatnagar V, Richard E, Han P, Sechriest VF 2nd, Lebedda M, Quinn K, Galarneau M. Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees. J Rehabil Res Dev. 2014;51(5):697–710. http://dx.doi.org/10.1682/JRRD.2013.06.0143 Slideshow Project DOI:10.1682/JRRD.2013.06.0143JSP Method Retrospective review of existing medical records of U.S. combat amputees injured 2001-2008 in Iraq or Afghanistan. In-theater combat casualty records (n = 145) documented Glasgow Coma Scale (GCS) scores and/or morphine, fentanyl, or no opioid treatment within hours of injury.

4. This article and any supplementary material should be cited as follows: Melcer T, Walker J, Bhatnagar V, Richard E, Han P, Sechriest VF 2nd, Lebedda M, Quinn K, Galarneau M. Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees. J Rehabil Res Dev. 2014;51(5):697–710. http://dx.doi.org/10.1682/JRRD.2013.06.0143 Slideshow Project DOI:10.1682/JRRD.2013.06.0143JSP Results GCS scores were not significantly associated with posttraumatic stress disorder (PTSD). Longitudinal modeling using 4 (yearly) time points showed significantly reduced likelihood of PTSD for patients treated with morphine (vs fentanyl). Reduced PTSD prevalence for morphine was significant, specifically among patients with traumatic brain injury during first 2 yr postinjury. PTSD prevalence, but not other disorders, increased between year 1 and years 2-4 postinjury.

5. This article and any supplementary material should be cited as follows: Melcer T, Walker J, Bhatnagar V, Richard E, Han P, Sechriest VF 2nd, Lebedda M, Quinn K, Galarneau M. Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees. J Rehabil Res Dev. 2014;51(5):697–710. http://dx.doi.org/10.1682/JRRD.2013.06.0143 Slideshow Project DOI:10.1682/JRRD.2013.06.0143JSP Conclusion Primary clinical implication: – Combat care physicians may consider PTSD prevention as potential benefit of choosing early morphine (with or without fentanyl) vs fentanyl alone Second implication: – Military and VA providers should screen for mental health disorders, particularly PTSD, during routine healthcare visits (e.g., primary care) for several years after injury.