Prevention of post-concussion-like symptoms in emergency room patients: Results from a two-center randomized controlled study comparing an early single-session Eye Movement Desensitization and Reprocessing intervention with usual care

ImportanceAfter a traumatic event, 10-20% of injured patients will suffer for several months from various symptoms, collectively termed post-concussion-like symptoms (PCLS), which can lead to a decline in quality of life. Moreover, recent findings suggested that this condition may also apply to patients with an acute medical condition. A preliminary randomized controlled trial suggested that this condition may be prevented by a single early short Eye Movement Desensitization and Reprocessing (EMDR) psychotherapeutic session delivered at the ER. ObjectiveThe present study was designed to compare the impact of the early EMDR intervention versus usual care on 3-month PCLS in patients presenting at the ER. Design, Setting, and Participants: This study was an open-label two-center comparative randomized controlled trial with phone follow-up assessments at 3 months. Eligible participants included adults ([≥]18 years old) presenting at the ER who have a high risk of PCLS using a 3-item scoring scale. InterventionsThe randomization groups were as follows: (i) EMDR Recent Traumatic Episode Protocol (R-TEP) intervention performed during the ER stay and (ii) usual care. Main Outcomes and Measures: The primary and secondary outcomes were respectively the frequency of PCLS and PTSD at 3 months after the ER visit. ResultsThis study included 313 patients with a high risk of PCLS who were randomized into two groups; of these patients, 219 were contacted by phone at 3 months. There was no difference in the primary outcome (EMDR: 53.8% vs. Control: 49.6%), but for the secondary outcome, the occurrence of PTSD was greater in the intervention group (9.4% vs. 2.7%, p = 0.04). In the EMDR group, a high level of self-assessed stress at admission (>6) was strongly associated with persistent PCLS (76.9% vs. 40.9%, p = 0.04). Conclusion and RelevanceThe present results showed that a single EMDR R-TEP session did not reduce the incidence of PCLS at 3 months in patients admitted to the ER. However, the rate of PTSD was higher in the EMDR group. These results suggest that more data should be collected to define which treatment options may be offered to patients attending the ER and the role that psychologist skill plays in this process. Trial registrationClinicalTrials.gov identifier NCT03400813. Key pointsO_ST_ABSQuestionC_ST_ABSDoes early EMDR in the emergency room reduce the incidence of PCLS at 3 months after care? FindingsIn patients admitted to the ER, a single EMDR R-TEP session did not reduce the incidence of PCLS at 3 months, especially among patients who reported a high level of stress at admission. MeaningThe present results suggest that more data will be necessary to determine the available treatment options for patients attending the ER and the role that psychologist skill plays in this process.