Holowka Darren W, Marx Brian P, Gates Margaret A, Litman Heather J, Ranganathan Gayatri, Rosen Raymond C, Keane Terence M
National Center for PTSD, VA Boston Healthcare System.
New England Research Institutes.
J Consult Clin Psychol. 2014 Aug;82(4):569-579. doi: 10.1037/a0036347. Epub 2014 Apr 14.
Administrative planning and policy decisions frequently rely on diagnostic data extracted from large electronic databases. However, the accuracy of this diagnostic information is uncertain. The present study examined the degree to which various diagnoses of posttraumatic stress disorder (PTSD) within Department of Veterans Affairs (VA) electronic databases were concordant with PTSD diagnostic status determined by standardized diagnostic interview.
We interviewed 1,649 veterans of the Iraq and Afghanistan wars using the PTSD Module of the Structured Clinical Interview for DSM-IV (SCID). Participants also completed other interview-based and self-report measures of psychopathology and provided consent to access their electronic medical records (EMRs).
Concordance between database diagnosis and SCID diagnosis was 72.3% for current PTSD and 79.4% for lifetime PTSD. We observed associations between concordance status and combat exposure, PTSD symptom presentation, comorbid anxiety and depression, and psychosocial impairment. Veterans with false-negative PTSD diagnoses in the EMR were more likely to report lower levels of combat exposure, panic, and PTSD avoidance symptoms. Veterans with false-positive PTSD diagnoses in the EMR were more likely to report treatment seeking for emotional problems and less overall functional impairment.
Although the majority of participants were concordant for PTSD status, over 25% of EMR diagnoses differed from those obtained in the diagnostic interview, with varying proportions of false positives and false negatives. Overall, those individuals with the most and least severe symptom presentations in the diagnostic interview were more likely to be accurately classified.
行政规划和政策决策常常依赖于从大型电子数据库中提取的诊断数据。然而，这些诊断信息的准确性尚不确定。本研究考察了退伍军人事务部（VA）电子数据库中各种创伤后应激障碍（PTSD）诊断与标准化诊断访谈确定的PTSD诊断状态的一致程度。
我们使用《精神疾病诊断与统计手册》第四版（DSM-IV）结构化临床访谈的PTSD模块对1649名伊拉克和阿富汗战争退伍军人进行了访谈。参与者还完成了其他基于访谈和自我报告的精神病理学测量，并同意获取他们的电子病历（EMR）。
当前PTSD的数据库诊断与SCID诊断的一致性为72.3%，终生PTSD的一致性为79.4%。我们观察到一致性状态与战斗暴露、PTSD症状表现、共病焦虑和抑郁以及心理社会功能损害之间的关联。电子病历中PTSD诊断为假阴性的退伍军人更有可能报告较低水平的战斗暴露、惊恐和PTSD回避症状。电子病历中PTSD诊断为假阳性的退伍军人更有可能报告因情绪问题寻求治疗，且总体功能损害较小。
尽管大多数参与者的PTSD状态一致，但超过25%的电子病历诊断与诊断访谈中获得的诊断不同，假阳性和假阴性的比例各不相同。总体而言，诊断访谈中症状表现最严重和最不严重的个体更有可能被准确分类。
