Stoll C, Kapfhammer H P, Rothenhäusler H B, Haller M, Briegel J, Schmidt M, Krauseneck T, Durst K, Schelling G
Dept. of Anaesthesiology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
Intensive Care Med. 1999 Jul;25(7):697-704. doi: 10.1007/s001340050932.
Many survivors of critical illness and intensive care unit (ICU) treatment have traumatic memories such as nightmares, panic or pain which can be associated with the development of posttraumatic stress disorder (PTSD). In order to simplify the rapid and early detection of PTSD in such patients, we modified an existing questionnaire for diagnosis of PTSD and validated the instrument in a cohort of ARDS patients after long-term ICU therapy.
Follow-up cohort study.
The 20-bed ICU of a university teaching hospital.
A cohort of 52 long-term survivors of the acute respiratory distress syndrome (ARDS).
The questionnaire was administered to the study cohort at two time points 2 years apart. At the second evaluation, the patients underwent a structured interview with two trained psychiatrists to diagnose PTSD according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. The reliability and validity of the questionnaire was then estimated and its specificity, sensitivity and optimal decision threshold determined using receiver operating characteristic (ROC) curve analyses.
The questionnaire showed a high internal consistency (Crohnbach's alpha = 0.93) and a high test-retest reliability (intraclass correlation coefficient alpha = 0.89). There was evidence of construct validity by a linear relationship between scores and the number of traumatic memories from the ICU the patients described (Spearman's rho = 0.48, p < 0.01). Criterion validity was demonstrated by ROC curve analyses resulting in a sensitivity of 77.0% and a specificity of 97.5% for the diagnosis of PTSD.
The questionnaire was found to be a responsive, valid and reliable instrument to screen survivors of intensive care for PTSD.
许多危重病幸存者及重症监护病房（ICU）治疗患者都有创伤性记忆，如噩梦、恐慌或疼痛，这些可能与创伤后应激障碍（PTSD）的发生有关。为了简化对此类患者PTSD的快速早期检测，我们修改了一份现有的PTSD诊断问卷，并在一组接受长期ICU治疗的急性呼吸窘迫综合征（ARDS）患者中对该工具进行了验证。
随访队列研究。
一所大学教学医院的20张床位的ICU。
一组52名急性呼吸窘迫综合征（ARDS）的长期幸存者。
在相隔2年的两个时间点对研究队列进行问卷调查。在第二次评估时，患者接受了两位经过培训的精神科医生的结构化访谈，以根据《精神疾病诊断与统计手册》第4版（DSM-IV）标准诊断PTSD。然后评估问卷的信度和效度，并使用受试者工作特征（ROC）曲线分析确定其特异性、敏感性和最佳决策阈值。
该问卷显示出较高的内部一致性（Cronbach's α = ０.93）和较高的重测信度（组内相关系数α = ０.89）。有证据表明，得分与患者描述的来自ICU的创伤性记忆数量之间存在线性关系，从而证明了结构效度（Spearman相关系数ρ = ０.48，p < 0.01）。ROC曲线分析证明了效标效度，诊断PTSD的敏感性为77.0%，特异性为97.5%。
该问卷被发现是一种用于筛查ICU幸存者PTSD的反应灵敏、有效且可靠的工具。
