Bryant Richard A, Creamer Mark, O'Donnell Meaghan L, Silove Derrick, McFarlane Alexander C
School of Psychology, University of New South Wales, Sydney, Australia.
J Clin Psychiatry. 2008 Jun;69(6):923-9. doi: 10.4088/jcp.v69n0606.
Previous studies investigating the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) have reported mixed findings and have been flawed by small sample sizes and single sites. This study addresses these limitations by conducting a large-scale and multisite study to evaluate the extent to which ASD predicts subsequent PTSD.
Between April 2004 and April 2005, patients admitted consecutively to 4 major trauma hospitals across Australia (N = 597) were randomly selected and assessed for ASD (DSM-IV criteria) during hospital admission (within 1 month of trauma exposure) and were subsequently reassessed for PTSD 3 months after the initial assessment (N = 507).
Thirty-three patients (6%) met criteria for ASD, and 49 patients (10%) met criteria for PTSD at the 3-month follow-up assessment. Fifteen patients (45%) diagnosed with ASD and 34 patients (7%) not diagnosed with ASD subsequently met criteria for PTSD. The positive predictive power of PTSD criteria in the acute phase (0.60) was a better predictor of chronic PTSD than the positive predictive power of ASD (0.46).
The majority of people who develop PTSD do not initially meet criteria for ASD. These data challenge the proposition that the ASD diagnosis is an adequate tool to predict chronic PTSD.
以往关于急性应激障碍（ASD）与创伤后应激障碍（PTSD）关系的研究结果不一，且存在样本量小和单中心的缺陷。本研究通过开展大规模多中心研究来评估ASD预测后续PTSD的程度，以解决这些局限性。
在2004年4月至2005年4月期间，从澳大利亚4家主要创伤医院连续收治的患者中随机选取（N = 597），在入院期间（创伤暴露后1个月内）依据《精神疾病诊断与统计手册》第四版（DSM-IV）标准对其进行ASD评估，并在初次评估3个月后对PTSD进行再次评估（N = 507）。
在3个月的随访评估中，33例患者（6%）符合ASD标准，49例患者（10%）符合PTSD标准。15例（45%）被诊断为ASD的患者及34例（7%）未被诊断为ASD的患者随后符合PTSD标准。急性期PTSD标准的阳性预测能力（0.60）比ASD的阳性预测能力（0.46）更能预测慢性PTSD。
大多数发生PTSD的人最初并不符合ASD标准。这些数据对ASD诊断是预测慢性PTSD的充分工具这一观点提出了挑战。
