创伤幸存者筛查量表的验证：美国创伤外科学会多机构试验。
Validation of the Injured Trauma Survivor Screen: An American Association for the Surgery of Trauma multi-institutional trial.
机构信息
From the Mental Health Division (J.C.H.), Milwaukee VA Medical Center, Milwaukee, Wisconsin; Division of Trauma and Acute Care Surgery, Department of Surgery (E.H.-H., A.B., K.J.-C., A.T.S., M.A.d.M., T.A.d.R.-C.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Psychiatry (K.M., B.J.), Virginia Commonwealth University, Richmond, Virginia; Department of Surgery (R.N.S.), School of Medicine, Emory University, Atlanta, Georgia; Department of Surgery (D.L., M.C., K.J.B.), Oregon Health & Science University, Portland, Oregon; and Comprehensive Injury Center (C.B.), Medical College of Wisconsin, Milwaukee, Wisconsin.
出版信息
J Trauma Acute Care Surg. 2021 May 1;90(5):797-806. doi: 10.1097/TA.0000000000003079.
BACKGROUND
Psychological distress is common following a traumatic injury event. The Injured Trauma Survivor Screen (ITSS) was developed at a level 1 trauma center to assess for posttraumatic stress disorder (PTSD) and major depressive episode (MDE) following admission for a traumatic injury. The ITSS sensitivity and specificity were analyzed 1 to 3 and 6 to 9 months postinjury to test the validity across trauma centers.
METHOD
Four level 1 trauma centers from the East, Midwest, South, and West in the United States recruited 375 eligible adult inpatients (excluded participants included those with moderate or severe traumatic brain injury, whose injury was self-inflicted, were noncommunicative, or were non-English speaking). Baseline sample (White/Caucasian, 63.2%; male, 62.4%; mean (SD) age, 45 (17.11) years; injured by motor vehicle collision, 42.4%) measurements were conducted during index hospitalization. At first follow-up, 69.6% (n = 261) were retained; at second follow-up, 61.3% (n = 230) were retained. Measurements included the ITSS, PTSD Checklist for DSM-5, Center for Epidemiologic Studies Depression Scale-Revised, and Clinician-Administered PTSD Scaled for DSM 5.
RESULTS
At follow-up 1, the ITSS PTSD subscale had a sensitivity of 75% and specificity of 78.8%, and the MDE subscale had a sensitivity of 80.4% and specificity of 65.6%. At follow-up 2, the PTSD subscale had a sensitivity of 72.7% and specificity of 83.1%, and the MDE subscale had a sensitivity of 76.1% and specificity of 68.3%. A combined risk group using two symptom based measures administered at baseline produced increased specificity.
CONCLUSION
The nine-item ITSS continues to be an efficient and effective risk screen for PTSD and MDE following traumatic injury requiring hospitalization. This multi-institutional validation study creates a solid foundation for further exploration of the generalizability of this screen's psychometric properties in distinct populations.
LEVEL OF EVIDENCE
Prognostic study, level III.
背景
心理困扰在创伤后事件后很常见。受伤创伤幸存者筛查（ITSS）是在一级创伤中心开发的，用于评估创伤后住院期间创伤后应激障碍（PTSD）和重度抑郁发作（MDE）。分析了受伤后 1 至 3 个月和 6 至 9 个月的 ITSS 敏感性和特异性，以检验跨创伤中心的有效性。
方法
美国东部、中西部、南部和西部的四个一级创伤中心招募了 375 名符合条件的成年住院患者（排除的参与者包括中度或重度创伤性脑损伤、伤害是自我造成的、无法交流或非英语的患者）。基线样本（白人/高加索人，63.2%；男性，62.4%；平均（SD）年龄，45（17.11）岁；机动车碰撞受伤，42.4%）在住院期间进行测量。第一次随访时，保留了 69.6%（n=261）；第二次随访时，保留了 61.3%（n=230）。测量包括 ITSS、DSM-5 创伤后应激障碍检查表、流行病学研究中心抑郁量表修订版和临床医生管理 PTSD 量表 5。
结果
在随访 1 时，ITSS PTSD 量表的敏感性为 75%，特异性为 78.8%，MDE 量表的敏感性为 80.4%，特异性为 65.6%。在随访 2 时，PTSD 量表的敏感性为 72.7%，特异性为 83.1%，MDE 量表的敏感性为 76.1%，特异性为 68.3%。使用在基线时进行的两种基于症状的测量组合的风险组提高了特异性。
结论
九级 ITSS 仍然是创伤后需要住院治疗的创伤后 PTSD 和 MDE 的有效风险筛查工具。这项多机构验证研究为进一步探索该筛查工具在不同人群中的心理测量特性的可推广性奠定了坚实的基础。
证据水平
预后研究，III 级。
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