Department of Psychiatry and Behavioral Sciences, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Group, Baltimore, MD; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
Department of Psychiatry and Behavioral Sciences, Baltimore, MD.
Chest. 2013 Jul;144(1):24-31. doi: 10.1378/chest.12-0908.
Survivors of acute lung injury (ALI) and other critical illnesses often experience substantial posttraumatic stress disorder (PTSD) symptoms. However, most questionnaires have not been validated against a PTSD diagnostic reference standard in this patient population. Hence, in the current study of survivors of ALI, we evaluated the Impact of Events Scale-Revised (IES-R), a questionnaire measure of PTSD symptoms, against the Clinician-Administered PTSD Scale (CAPS), the current state-of-the-art PTSD diagnostic reference standard, which also provides a quantitative assessment of PTSD symptoms.
We evaluated the IES-R questionnaire vs the CAPS diagnostic interview in 60 of 77 consecutively recruited survivors of ALI from two prospective cohort studies of patients 1 to 5 years after ALI.
The IES-R total score (range: 0.0-3.2) and the CAPS total severity score (range: 0-70) were strongly related (Pearson r=0.80, Spearman ρ=0.69). Using CAPS data, eight of the 60 patients (13%) had PTSD at the time of assessment, and an additional eight patients had partial PTSD (total prevalence, 27%). In a receiver operating characteristics curve analysis with CAPS PTSD or partial PTSD as criterion variables, the area under the curve ranged from 95% (95% CI, 88%-100%) to 97% (95% CI, 92%-100%). At an IES-R threshold of 1.6, with the same criterion variables, sensitivities ranged from 80% to 100%, specificities 85% to 91%, positive predictive values 50% to 75%, negative predictive values 93% to 100%, positive likelihood ratios 6.5 to 9.0, negative likelihood ratios 0.0 to 0.2, and efficiencies 87% to 90%.
The IES-R appears to be an excellent brief PTSD symptom measure and screening tool in ALI survivors.
急性肺损伤（ALI）和其他危重病幸存者经常经历大量创伤后应激障碍（PTSD）症状。然而，大多数问卷都没有针对这一患者群体的 PTSD 诊断参考标准进行验证。因此，在目前对 ALI 幸存者的研究中，我们评估了修订后的事件影响量表（IES-R），这是一种 PTSD 症状问卷测量工具，与目前最先进的 PTSD 诊断参考标准临床医生管理 PTSD 量表（CAPS）相对照，该量表还提供了 PTSD 症状的定量评估。
我们评估了 IES-R 问卷与 CAPS 诊断访谈在 77 名连续招募的 ALI 幸存者中的 60 名，这是两个前瞻性队列研究的患者，时间为 ALI 后 1 至 5 年。
IES-R 总分（范围：0.0-3.2）和 CAPS 总严重程度评分（范围：0-70）之间存在很强的相关性（Pearson r=0.80，Spearman ρ=0.69）。使用 CAPS 数据，60 名患者中有 8 名（13%）在评估时患有 PTSD，另外 8 名患者患有部分 PTSD（总患病率为 27%）。在以 CAPS PTSD 或部分 PTSD 为标准变量的受试者工作特征曲线分析中，曲线下面积范围为 95%（95%CI，88%-100%）至 97%（95%CI，92%-100%）。在 IES-R 阈值为 1.6 的情况下，使用相同的标准变量，灵敏度范围为 80%至 100%，特异性为 85%至 91%，阳性预测值为 50%至 75%，阴性预测值为 93%至 100%，阳性似然比为 6.5 至 9.0，阴性似然比为 0.0 至 0.2，效率为 87%至 90%。
IES-R 似乎是一种优秀的 ALI 幸存者 PTSD 症状简短测量和筛查工具。
