Walker Edward A, Newman Elana, Dobie Dorcas J, Ciechanowski Paul, Katon Wayne
Division of Consultation-Liaison Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
Gen Hosp Psychiatry. 2002 Nov-Dec;24(6):375-80. doi: 10.1016/s0163-8343(02)00203-7.
Although Post-traumatic Stress Disorder (PTSD) is common among patients seeking care at medical clinics, little is known about the performance of screening instruments for this disorder in these settings. Previous studies of acute trauma populations using the PTSD Checklist (PCL) have suggested that scores of 45-50 provide the best discrimination between cases and noncases. We gave the PCL to 1,225 randomly selected women enrolled in an HMO. After interviewing a sample of 261 of these women using a structured, clinician-administered PTSD interview, we compared the results of the PCL to the clinician interviews over a range of possible cut scores using Receiver Operating Characteristic analysis. The optimum balance of sensitivity and specificity for this population was a score of 30, yielding a sensitivity of.82 and specificity of.76. The positive and negative likelihood ratios for this cut score were 3.40 and 0.24, respectively. By comparison, the use of 45 as a cut score would result in very low sensitivity (.36) in this setting. The lower cut score found in this study may indicate that the use of previously published cut scores of 45-50 may not optimize the function of the PCL as a screening tool outside of acute trauma settings due to an unacceptably high number of false negative cases.
尽管创伤后应激障碍（PTSD）在前往医疗诊所就诊的患者中很常见，但对于这些环境中该障碍筛查工具的性能却知之甚少。先前针对急性创伤人群使用创伤后应激障碍检查表（PCL）的研究表明，45 - 50分能最好地区分病例和非病例。我们将PCL发放给了1225名随机选取的参加健康维护组织（HMO）的女性。在使用结构化的、由临床医生进行的PTSD访谈对其中261名女性进行抽样访谈后，我们使用接受者操作特征分析，在一系列可能的临界分数范围内，将PCL的结果与临床医生访谈的结果进行了比较。该人群敏感性和特异性的最佳平衡分数为30分，敏感性为0.82，特异性为0.76。这个临界分数的阳性似然比和阴性似然比分别为3.40和0.24。相比之下，在这种情况下将45作为临界分数会导致非常低的敏感性（0.36）。本研究中发现的较低临界分数可能表明，由于假阴性病例数量高得不可接受，在急性创伤环境之外使用先前公布的45 - 50分临界分数可能无法使PCL作为筛查工具的功能达到最优。
