Trauma Ward Mental Health Family Notification Delay and Post-Traumatic Stress Disorder Symptom Persistence Among Adult Inpatients in Ghanaian Referral Hospitals: A Target-Trial Emulation of Disclosure Timing Windows

Family notification delay after traumatic injury is a modifiable feature of trauma ward care, yet its relationship to post-traumatic stress disorder symptom persistence is difficult to study because notification timing is not randomised and is confounded by injury severity, ward workload and family availability. The design uses eight, sixteen, twenty-four and thirty-two clusters, effect sizes of three, five and eight percentage points, and two thousand replications per design cell, under a between-cluster standard deviation of 6.0, a residual standard deviation of 4.5 and an intraclass correlation of 0.64. Power curves, minimum detectable effects and coefficient estimates are reported across the design grid. The analysis indicates that fifty-four clusters are required to detect a five-percentage-point effect at eighty per cent power under the declared variance structure, and that the intraclass correlation of 0.64 imposes a substantial design effect that limits the informativeness of small cluster counts. The framework clarifies the conditions under which disclosure timing can be credibly evaluated and identifies the cluster counts at which inference becomes defensible.