Faculty Collaboration Database

Six-month follow-up of the injured trauma survivor screen: Clinical implications and future directions. J Trauma Acute Care Surg 2018 Aug;85(2):263-270

Date

04/20/2018

Pubmed ID

29672441

Pubmed Central ID

PMC6081305

DOI

10.1097/TA.0000000000001944

Scopus ID

2-s2.0-85051128961 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: The injured trauma survivor screen (ITSS) has been shown to predict posttraumatic stress disorder (PTSD) and depression risk at 1 month after traumatic injury. This study explored the ability of the ITSS to predict chronic distress after injury, as well as the impact of combining the ITSS with an additional screening measure.

METHODS: Patients were enrolled following admission to a Level I trauma center. Baseline measurements were collected during initial hospitalization, and follow-up measures were collected an average of 6.5 months after injury. Receiver operating characteristic (ROC) curve analyses were run to determine predictive accuracy, controlling for participants who had mental health intervention and for those who experienced additional potentially psychologically traumatic events since their injury event.

RESULTS: Utilizing a cut score of 2, the ITSS PTSD scale had a sensitivity of 85.42%, specificity of 67.35%, negative predictive value (NPV) of 91.9% and positive predictive value (PPV) of 51.4%. The combined PTSD risk group (risk positive on the baseline ITSS and the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) had a sensitivity of 72.92%, specificity of 81.63%, NPV of 88.2%, and PPV of 61.6%. Also using a cut score of 2, the ITSS Depression Scale had a sensitivity of 72.50%, specificity of 70.29%, NPV of 91.1%, and PPV of 37.9%.

CONCLUSION: The nine-item ITSS, which takes approximately 5 minutes to administer, is a stable screening tool for predicting those most at risk for PTSD and/or depression 6 months after admission to a Level I trauma center following traumatic injury. The combined PTSD risk group data provide evidence that symptom evaluation by a psychologist can improve specificity. These results further inform the recommendation of the American College of Surgeons Committee on Trauma regarding PTSD and depression screening in trauma centers.

LEVEL OF EVIDENCE: Prognostic study, level III.

Author List

Hunt JC, Chesney SA, Brasel K, deRoon-Cassini TA

Author

Terri A. deRoon Cassini PhD Center Director, Professor in the Surgery department at Medical College of Wisconsin

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

Adult
Depression
Female
Follow-Up Studies
Glasgow Coma Scale
Hospitalization
Humans
Logistic Models
Male
Mass Screening
Middle Aged
Psychiatric Status Rating Scales
ROC Curve
Risk Factors
Stress Disorders, Post-Traumatic
Survivors
Trauma Centers
Wounds and Injuries