After the Paris attacks, a trauma treatment chosen for speed
- A medRxiv preprint, not peer-reviewed, reports a preference-based, two-arm multicentre trial in French public hospitals after the November 2015 Paris attacks: 332 adults, mostly with PTSD, received Reconsolidation Therapy (n = 262) or treatment as usual (n = 70).
- At week 52, PTSD symptom scores fell by 38.14 points with Reconsolidation Therapy and by 35.02 with treatment as usual (p = .297). At week 7 the difference was 5.11 points in favour of Reconsolidation Therapy (p = .041).
- 160 clinicians were trained in two days. The treatment is six weekly 25-minute sessions of trauma recall under oral propranolol.
- Annual sick-leave costs were 4147€ (95% CI 3 394 to 5 012) with Reconsolidation Therapy and 7 386€ (95% CI 5 416 to 10 340) with treatment as usual (p = .01). Reconsolidation Therapy had a 55.4% probability of being cheaper and more effective; for treatment as usual the figure was 8.4%.
Sooner or later a manager asks whether the team should learn Reconsolidation Therapy. The case will rest on speed, cost and a two-day course. A medRxiv preprint from the Paris Mémoire Vive project, not yet peer-reviewed, puts a number on each.
Two days of training, six short sessions
In 2016, 150 clinicians and research staff at 15 French hospitals were trained over two days; ten more followed in Fort-de-France in 2017. The patient takes 1 mg/kg of oral propranolol 75 minutes before a 25-minute session, once a week for six weeks, writes an account of the worst event and reads it aloud at each later session. Treatment as usual was whatever the centre offered, most often paroxetine, CBT, EMDR, supportive or psychodynamic therapy, with no session limit. Patients chose their arm after talking with their doctor.
Level at one year, ahead at week 7
At week 52 symptom scores had fallen by 38.14 and 35.02 points (p = .297). At week 7, a week after the last session, Reconsolidation Therapy was 5.11 points ahead (p = .041); by week 13 the gap was no longer significant. Direct annual costs did not differ significantly (2 746€ and 3 289€, p = .47), and QALYs were 0.809 and 0.807. The saving sat in sick leave: 4147€ against 7 386€ a year. Five patients on Reconsolidation Therapy stopped because of adverse events.
Answering the manager and the client
What the hospital network bought was time. Two days of training and six 25-minute sessions per patient reached the outcome of usual care earlier. After a mass-casualty event, when the waiting list is the problem, that is a service argument. The authors write that their paper should not be read as evidence that the method outperforms other PTSD treatments.
So keep the two conversations apart. To a manager, the case is capacity and sick-leave days. To a client, say plainly that propranolol needs a physician, an ECG and blood-pressure checks, and that at one year the result matched usual care.
Two days of training and six short sessions reached the outcome of usual care sooner, which is an argument about capacity rather than about a better outcome.
This is a preprint that has not been peer-reviewed, and patients chose their treatment, so groups were balanced by propensity-score weighting and unmeasured differences may remain. Assessments were not double-blind, and treatment as usual was a mixed set of practices whose fidelity was not monitored; the authors state that the findings await replication. The disclosure statement reports no financial relationship with commercial interests; the first author developed the 16-hour training and delivered it to the clinicians.