Wade Roy, Becker Brandon D, Bevans Katherine B, Ford Derek C, Forrest Christopher B
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Am J Prev Med. 2017 Feb;52(2):163-172. doi: 10.1016/j.amepre.2016.09.033. Epub 2016 Nov 16.
Clinicians require tools to rapidly identify individuals with significant childhood adversity as part of routine primary care. The goal of this study was to shorten the 11-item Behavioral Risk Factor Surveillance System Adverse Childhood Experiences (ACEs) measure and evaluate the feasibility and validity of this shortened measure as a screener to identify adults who have experienced significant childhood adversity.
Statistical analysis was conducted in 2015. ACE item responses obtained from 2011-2012 Behavioral Risk Factor Surveillance System data were combined to form a sample of 71,413 adults aged ≥18 years. The 11-item Behavioral Risk Factor Surveillance System ACE measure was subsequently reduced to a two-item screener by maintaining the two dimensions of abuse and household stressors and selecting the most prevalent item within each dimension.
The screener included household alcohol and childhood emotional abuse items. Overall, 42% of respondents and at least 75% of the individuals with four or more ACEs endorsed one or both of these experiences. Using the 11-item ACE measure as the standard, a cut off of one or more ACEs yielded a sensitivity of 99%, but specificity was low (66%). Specificity improved to 94% when using a cut off of two ACEs, but sensitivity diminished (70%). There was no substantive difference between the 11-and two-item ACE measures in their strength of association with an array of health outcomes.
A two-item ACE screener appropriate for rapid identification of adults who have experienced significant childhood adversity was developed.
临床医生需要工具来在常规初级保健中快速识别有重大童年逆境经历的个体。本研究的目的是缩短11项行为危险因素监测系统童年不良经历（ACEs）量表，并评估该缩短版量表作为筛查工具以识别有重大童年逆境经历成年人的可行性和有效性。
2015年进行了统计分析。从2011 - 2012年行为危险因素监测系统数据中获取的ACE项目回答被合并，形成了一个由71413名年龄≥18岁成年人组成的样本。随后，通过保留虐待和家庭压力源这两个维度，并在每个维度中选择最常见的项目，将11项行为危险因素监测系统ACE量表简化为一个两项筛查工具。
该筛查工具包括家庭酗酒和童年情感虐待项目。总体而言，42%的受访者以及至少75%有四项或更多ACEs的个体认可了其中一项或两项经历。以11项ACE量表为标准，一项或多项ACEs的临界值敏感性为99%，但特异性较低（66%）。使用两项ACEs的临界值时，特异性提高到94%，但敏感性降低（70%）。11项和两项ACE量表在与一系列健康结果的关联强度上没有实质性差异。
开发了一种适用于快速识别有重大童年逆境经历成年人的两项ACE筛查工具。
