Department of Clinical Social Work, Nationwide Children's Hospital, Columbus, OH.
Department of Pediatrics, St. Louis Children's Hospital and Washington University in St. Louis, St. Louis, MO.
J Pediatr. 2019 Jul;210:127-133. doi: 10.1016/j.jpeds.2019.03.016. Epub 2019 May 2.
To determine the Screening Tool for Early Predictors of Post-Traumatic Stress Disorder (STEPP) test accuracy in identifying children with new mental health diagnoses and psychotropic medications prescribed within 12 months after unintentional injuries in a managed-Medicaid population.
We conducted a secondary analysis of a retrospective cohort that investigated mental health diagnoses and psychotropic medications pre- and post-injury in children ≤18 years of age treated at a pediatric trauma center from 2005 to 2015 (n = 2208). For this study, we analyzed children with STEPP scores from their injury admission (n = 85). For children without previous mental health diagnoses or psychotropic prescriptions, we calculated the sensitivity, specificity, and positive and negative predictive values for the child and parent STEPP.
Of 78 children without previous diagnoses, 12 had post-injury mental health diagnoses. Of 68 children without previous psychotropic medication use, 10 had psychotropic medications prescribed. The child STEPP sensitivity was 8.3% for mental health diagnoses (95% CI 0.2, 38.5) and 10% for psychotropic medications (95% CI 0.3, 44.5). The child STEPP specificity was 77.3% for mental health diagnoses (95% CI 65.3, 86.7) and 75.9% for psychotropic medication (95% CI 62.8, 86.1).
We found that the STEPP performed poorly in identifying children who received new mental health diagnoses and new psychotropic medications following injury.
确定用于识别意外伤害后 12 个月内出现新心理健康诊断和开处精神类药物的儿童的创伤后应激障碍早期预测筛查工具（STEPP）的准确性，该研究对象为参与管理式医疗保健的人群。
我们对 2005 年至 2015 年期间在儿科创伤中心接受治疗的年龄≤18 岁的儿童（n=2208）进行了回顾性队列研究，分析了该研究中儿童的精神健康诊断和损伤前后的精神类药物使用情况。在此项研究中，我们分析了 85 名损伤入院时 STEPP 评分的儿童。对于无既往精神健康诊断或精神类药物处方的儿童，我们计算了儿童和家长 STEPP 的敏感性、特异性、阳性预测值和阴性预测值。
在 78 名无既往诊断的儿童中，有 12 名在损伤后出现了心理健康诊断。在 68 名无既往精神类药物使用的儿童中，有 10 名开处了精神类药物。儿童 STEPP 的心理健康诊断敏感性为 8.3%（95%CI 0.2, 38.5），精神类药物敏感性为 10%（95%CI 0.3, 44.5）。儿童 STEPP 的心理健康诊断特异性为 77.3%（95%CI 65.3, 86.7），精神类药物特异性为 75.9%（95%CI 62.8, 86.1）。
我们发现 STEPP 无法准确识别受伤后出现新心理健康诊断和新精神类药物使用的儿童。
