From the Medical College of Wisconsin (J.C.H., T.A.D.), Department of Surgery, Division of Trauma and Acute Care Surgery, Milwaukee, Wisconsin; Marquette University (S.A.C.), Department of Psychology, Milwaukee, Wisconsin; Oregon Health and Science University (K.B.), Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Portland, Oregon.
J Trauma Acute Care Surg. 2018 Aug;85(2):263-270. doi: 10.1097/TA.0000000000001944.
The injured trauma survivor screen (ITSS) has been shown to predict posttraumatic stress disorder (PTSD) and depression risk at 1 month after traumatic injury. This study explored the ability of the ITSS to predict chronic distress after injury, as well as the impact of combining the ITSS with an additional screening measure.
Patients were enrolled following admission to a Level I trauma center. Baseline measurements were collected during initial hospitalization, and follow-up measures were collected an average of 6.5 months after injury. Receiver operating characteristic (ROC) curve analyses were run to determine predictive accuracy, controlling for participants who had mental health intervention and for those who experienced additional potentially psychologically traumatic events since their injury event.
Utilizing a cut score of 2, the ITSS PTSD scale had a sensitivity of 85.42%, specificity of 67.35%, negative predictive value (NPV) of 91.9% and positive predictive value (PPV) of 51.4%. The combined PTSD risk group (risk positive on the baseline ITSS and the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) had a sensitivity of 72.92%, specificity of 81.63%, NPV of 88.2%, and PPV of 61.6%. Also using a cut score of 2, the ITSS Depression Scale had a sensitivity of 72.50%, specificity of 70.29%, NPV of 91.1%, and PPV of 37.9%.
The nine-item ITSS, which takes approximately 5 minutes to administer, is a stable screening tool for predicting those most at risk for PTSD and/or depression 6 months after admission to a Level I trauma center following traumatic injury. The combined PTSD risk group data provide evidence that symptom evaluation by a psychologist can improve specificity. These results further inform the recommendation of the American College of Surgeons Committee on Trauma regarding PTSD and depression screening in trauma centers.
Prognostic study, level III.
受伤创伤幸存者筛查（ITSS）已被证明可预测创伤后 1 个月的创伤后应激障碍（PTSD）和抑郁风险。本研究探讨了 ITSS 预测受伤后慢性困扰的能力，以及将 ITSS 与额外的筛查措施相结合的影响。
患者在入住一级创伤中心后被纳入研究。在初始住院期间收集基线测量值，并在受伤后平均 6.5 个月进行随访测量。进行了受试者工作特征（ROC）曲线分析，以确定预测准确性，同时控制了接受心理健康干预的参与者和自受伤事件以来经历了其他潜在心理创伤事件的参与者。
使用 2 分的截断值，ITSS PTSD 量表的灵敏度为 85.42%，特异性为 67.35%，阴性预测值（NPV）为 91.9%，阳性预测值（PPV）为 51.4%。PTSD 风险组（基线 ITSS 和精神障碍诊断与统计手册第 5 版 PTSD 清单上的 PTSD 风险阳性）的灵敏度为 72.92%，特异性为 81.63%，NPV 为 88.2%，PPV 为 61.6%。同样使用 2 分的截断值，ITSS 抑郁量表的灵敏度为 72.50%，特异性为 70.29%，NPV 为 91.1%，PPV 为 37.9%。
在一级创伤中心接受创伤后 6 个月，大约需要 5 分钟即可完成的九项 ITSS 是一种稳定的筛查工具，可预测 PTSD 和/或抑郁风险最高的患者。PTSD 风险组数据提供了证据，表明心理学家的症状评估可以提高特异性。这些结果进一步证明了美国外科医师学会创伤委员会关于创伤中心 PTSD 和抑郁筛查的建议。
预后研究，III 级。
