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Validation of the Injured Trauma Survivor Screen: An American Association for the Surgery of Trauma multi-institutional trial. J Trauma Acute Care Surg 2021 05 01;90(5):797-806



Pubmed ID




Scopus ID

2-s2.0-85105712241   1 Citation


BACKGROUND: Psychological distress is common following a traumatic injury event. The Injured Trauma Survivor Screen (ITSS) was developed at a level 1 trauma center to assess for posttraumatic stress disorder (PTSD) and major depressive episode (MDE) following admission for a traumatic injury. The ITSS sensitivity and specificity were analyzed 1 to 3 and 6 to 9 months postinjury to test the validity across trauma centers.

METHOD: Four level 1 trauma centers from the East, Midwest, South, and West in the United States recruited 375 eligible adult inpatients (excluded participants included those with moderate or severe traumatic brain injury, whose injury was self-inflicted, were noncommunicative, or were non-English speaking). Baseline sample (White/Caucasian, 63.2%; male, 62.4%; mean (SD) age, 45 (17.11) years; injured by motor vehicle collision, 42.4%) measurements were conducted during index hospitalization. At first follow-up, 69.6% (n = 261) were retained; at second follow-up, 61.3% (n = 230) were retained. Measurements included the ITSS, PTSD Checklist for DSM-5, Center for Epidemiologic Studies Depression Scale-Revised, and Clinician-Administered PTSD Scaled for DSM 5.

RESULTS: At follow-up 1, the ITSS PTSD subscale had a sensitivity of 75% and specificity of 78.8%, and the MDE subscale had a sensitivity of 80.4% and specificity of 65.6%. At follow-up 2, the PTSD subscale had a sensitivity of 72.7% and specificity of 83.1%, and the MDE subscale had a sensitivity of 76.1% and specificity of 68.3%. A combined risk group using two symptom based measures administered at baseline produced increased specificity.

CONCLUSION: The nine-item ITSS continues to be an efficient and effective risk screen for PTSD and MDE following traumatic injury requiring hospitalization. This multi-institutional validation study creates a solid foundation for further exploration of the generalizability of this screen's psychometric properties in distinct populations.

LEVEL OF EVIDENCE: Prognostic study, level III.

Author List

Hunt JC, Herrera-Hernandez E, Brandolino A, Jazinski-Chambers K, Maher K, Jackson B, Smith RN, Lape D, Cook M, Bergner C, Schramm AT, Brasel KJ, de Moya MA, deRoon-Cassini TA


Amber Brandolino in the CTSI department at Medical College of Wisconsin - CTSI
Andrew T. Schramm PhD Assistant Professor in the Surgery department at Medical College of Wisconsin
Terri A. deRoon Cassini PhD Center Director, Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Accidents, Traffic
Depressive Disorder, Major
Glasgow Coma Scale
Mass Screening
Middle Aged
Psychiatric Status Rating Scales
Risk Factors
Sensitivity and Specificity
Stress Disorders, Post-Traumatic
Trauma Centers
United States
Wounds and Injuries