Screening Tool Evaluates Psychological Risk Factors Linked to Adult Orthopedic Trauma

The American Academy of Orthopaedic Surgeons (AAOS) has released Appropriate Use Criteria (AUC) to help healthcare professionals determine appropriateness of early screening for psychosocial risk and protective factors in patients with adult orthopedic trauma. The treatment scenarios provided by this AUC stem from the recommendation in the Clinical Practice Guideline (CPG) issued by the AAOS in December 2019.

Developed in collaboration with the Major Extremity Trauma Research Consortium and funded by a Department of Defense research grant, this AUC is intended to offer guidance on decision factors for adults with severe extremity trauma. The AUC online tool provides clinicians algorithms on how to optimally evaluate the condition based on a patient’s various indications, including injury severity/type, pain intensity, magnitude of limitations, pre-morbid exposure to combat and pre-morbid psychiatric condition. It recommends specific next steps and procedures to ensure optimal recovery. These can include evaluation for mental health (anxiety, depression, and PTSD), evaluation for social support and stressors, and evaluation for coping and resilience. Each treatment recommendation is ranked by level of appropriateness.

The new AUC is geared towards the needs of military surgeons; however, healthcare professionals other than orthopaedic surgeons, including but not limited to adult primary care physicians, adult medicine specialists, physical therapists, occupational therapists, physician assistants, nurse practitioners who routinely see this patient population in various practice settings may benefit from this tool. This AUC tool is not intended for use as a benefits determination document.

The AUC tool offers accepted approaches to treatment and/or diagnosis and is not intended to be a fixed protocol. Patient care and treatment should always be based on a clinician’s independent medical judgment, giving the individual patient’s specific clinical circumstances. 

The full AUC for the evaluation of psychosocial factors influencing recovery from adult orthopedic trauma is available through AAOS’ OrthoGuidelines website and free mobile app. For more information on the development process for AAOS clinical practice guidelines, please reference the Clinical Practice Guideline Methodology.