Stress in Trauma Patients in Triage Categories 3-5

Assessment of Acute Stress and Main Sources of Concern Among Trauma Patients in Triage Categories 3-5 in the Emergency Department: A Prospective Observational Study

The aim of this study is to better understand what causes patients the most concern immediately after an injury. We would like to find out how stressed patients are and whether the main causes of stress are pain, fear regarding the severity of the injury, the possibility of surgery, uncertainty about treatment, concerns about family, children, work, finances, or something else.

Study Overview

• Status: Not yet recruiting
• Conditions: Trauma (Including Fractures)
• Intervention / Treatment: Other: Questionnaire and Physical Exam

Detailed Description

Traumatic injuries are a common reason for seeking care in an Emergency Department. Beyond the physical effects of an injury, patients may also experience considerable emotional stress. They may worry about pain, how serious the injury is, whether surgery will be necessary, how long recovery will take, possible long-term consequences, and how the injury may affect their family, children, work, or financial situation.

In patients who are medically stable, especially those with less immediately life-threatening injuries, this emotional burden is not always assessed in a structured way. However, these patients are often able to complete a short questionnaire about their concerns and stress. Understanding their experiences may help healthcare professionals improve communication, provide clearer information, and offer better support during emergency care.

The aim of this study is to measure acute stress in trauma patients and identify the concerns that matter most to them shortly after injury. For patients who are admitted to the hospital, the study will also examine how stress levels and the main sources of concern change during the first 24 hours after admission.

• Study Type: Observational
• Enrollment (Estimated): 300

Contacts and Locations

• Study Contact: Name: Gabriela K Pomper, MD, PHD; Phone Number: 003834254532; Email: gabrielakatharina@pozeska-bolnica.hr

Study Locations

• Croatia
  • Požega, Croatia, 34000
    • OŽB Požega
    • Contact: Director of the General County Hospital Požega., MD, PHD; Phone Number: 003834254506; Email: ivan.vukoja@pozeska-bolnica.hr
    • Contact: Head of Emergency Department, MD; Phone Number: 003834254804; Email: matko.šperanda@pozeska-bolnica.hr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of adult patients aged 18 years or older presenting to the Emergency Department with an acute traumatic injury and classified as triage category 3, 4, or 5. Eligible participants must be clinically stable after the initial medical assessment, able to understand the study information and questionnaires, and capable of providing written informed consent. Patients who require hospitalization will additionally complete a follow-up questionnaire approximately 24 hours after admission.

Description

Inclusion Criteria:

1. Age 18 years or older.
2. Presentation to the Emergency Department because of an acute traumatic injury.
3. Triage category 3, 4, or 5.
4. Clinical stability after the initial assessment.
5. Ability to understand the study information and the questionnaire.
6. Ability to provide written informed consent

Exclusion Criteria:

1. Triage category 1 or 2 (an acutely life-threatening condition or an immediate need for emergency medical or surgical intervention; hemodynamic or respiratory instability).
2. Severe impairment of consciousness, disorientation, or inability to cooperate.
3. Inability to provide informed consent; cognitive impairment or a language barrier preventing comprehension of the questions.
4. Severe alcohol or drug intoxication preventing valid completion of the questionnaire.
5. A situation in which completion of the questionnaire is inappropriate for medical, ethical, or organizational reasons.

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Triage Category 3; Clinically stable adult trauma patients classified as triage category 3 after initial emergency assessment.	Other: Questionnaire and Physical Exam; Participants complete a brief questionnaire assessing acute stress, pain, treatment-related concerns, family and work-related concerns, and perceived information and communication. The T0 questionnaire is administered after initial emergency assessment. Hospitalized participants complete an additional T1 questionnaire approximately 24 hours after admission.
Triage Category 4; Clinically stable adult trauma patients classified as triage category 4 after initial emergency assessment.	Other: Questionnaire and Physical Exam; Participants complete a brief questionnaire assessing acute stress, pain, treatment-related concerns, family and work-related concerns, and perceived information and communication. The T0 questionnaire is administered after initial emergency assessment. Hospitalized participants complete an additional T1 questionnaire approximately 24 hours after admission.
Triage Category 5; Clinically stable adult trauma patients classified as triage category 5 after initial emergency assessment.	Other: Questionnaire and Physical Exam; Participants complete a brief questionnaire assessing acute stress, pain, treatment-related concerns, family and work-related concerns, and perceived information and communication. The T0 questionnaire is administered after initial emergency assessment. Hospitalized participants complete an additional T1 questionnaire approximately 24 hours after admission.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Acute Stress Level	Overall level of acute stress measured using a numerical rating scale from 0 to 10, where 0 indicates no stress and 10 indicates the highest possible level of stress.	At day 1, after initial assessment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Individual Sources of Stress at T0	Severity of specific stressors, including pain, concerns about injury severity, possible surgery, anesthesia, treatment uncertainty, permanent consequences, family, children, work, and financial concerns, each rated on a 0-10 numerical scale.	At day 1, after initial Emergency Department assessment.
Difference in Overall Stress Between Triage Categories 3, 4, and 5	Description: Comparison of overall acute stress scores among trauma patients classified as triage category 3, 4, or 5.	At day 1.
Association Between Pain Intensity and Overall Stress	Description: Association between self-reported pain intensity and overall acute stress level, both measured on numerical rating scales from 0 to 10.	At day 1.
Overall Stress Score According to Injury Type and Anatomical Location	Overall stress will be assessed using a patient-reported 11-point Numeric Rating Scale (NRS) ranging from 0 to 10, where 0 indicates no stress and 10 indicates the highest imaginable level of stress. Overall stress scores will be compared according to the type of traumatic injury and the anatomical location of the injury. Injury type and anatomical location will be determined from the clinical assessment and medical documentation at presentation to the Emergency Department and categorized for analysis. Higher scores indicate a higher level of overall stress.	At day 1.
Change in Overall Stress Score Assessed by the Study-Specific Acute Trauma Stress Questionnaire From T0 to T1	Change in overall stress level between the initial Emergency Department assessment and approximately 24 hours after hospital admission among hospitalized participants.	From day 1 to approximately 24 hours after admission.
Change in Dominant Sources of Stress Assessed by the Study-Specific Acute Trauma Stress Questionnaire From T0 to T1	Change in the most important patient-reported sources of stress between the initial assessment and approximately 24 hours after admission.	From day 1 to approximately 24 hours after admission.
Correlation Between Overall Stress Score and Patient-Reported Information and Understanding Score	Correlation between the patient's overall stress level and the patient's perceived level of information and understanding regarding the current treatment plan. Overall stress will be assessed using a patient-reported Numeric Rating Scale (NRS) ranging from 0 to 10, where 0 indicates no stress and 10 indicates the highest imaginable level of stress. The perceived level of information and understanding of the treatment plan will be assessed using a patient-reported Numeric Rating Scale (NRS) ranging from 0 to 10, where 0 indicates feeling not informed/not understanding the treatment plan at all and 10 indicates feeling fully informed and having	At day 1 and, for hospitalized participants, approximately 24 hours after admission.

Collaborators and Investigators

• Sponsor: Gabriela Katharina Pomper

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): August 31, 2028
• Study Completion (Estimated): August 31, 2028

Study Registration Dates

• First Submitted: August 29, 2026
• First Submitted That Met QC Criteria: September 3, 2026
• First Posted (Actual): September 10, 2026

Study Record Updates

• Last Update Posted (Actual): September 10, 2026
• Last Update Submitted That Met QC Criteria: September 3, 2026
• Last Verified: September 1, 2026

More Information

Terms related to this study

• Keywords: trauma; emergency department; hospitalization; acute stress; emergency care
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Pathological Conditions, Signs and Symptoms; Emergencies; Wounds and Injuries; Health Care Quality, Access, and Evaluation; Investigative Techniques; Epidemiologic Methods; Therapeutics; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Behavior Control; Immobilization; Surveys and Questionnaires; Restraint, Physical
• Other Study ID Numbers: PozegaBolnica; Ur.broj: 02-7/3-3/2-2-2026 (Other Identifier: Ethics Committee of the General County Hospital Požega)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: ndividual participant data (IPD) will not be shared publicly because the study involves sensitive patient-reported psychological and clinical information collected in the acute trauma setting. Although the dataset will be pseudonymized, the relatively small study population and detailed clinical variables may still carry a potential risk of participant re-identification. Therefore, IPD will be restricted to the study investigators and will not be made publicly available.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No