Rahmat Saad, Velez Jessica, Farooqi Muhammad, Smiley Abbas, Prabhakaran Kartik, Rhee Peter, Dornbush Rhea, Ferrando Stephen, Smolin Yvette
Department of Psychiatry and Behavioral Sciences, Westchester Medical Center, Valahlla, NY, USA.
Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA.
Trauma Surg Acute Care Open. 2021 Mar 23;6(1):e000623. doi: 10.1136/tsaco-2020-000623. eCollection 2021.
Post-traumatic stress disorder (PTSD) has debilitating psychiatric and medical consequences. The purpose of this study was to identify whether PTSD diagnosis and PTSD symptom scale score (PTSD severity) could be predicted by assessing peritraumatic experiences using a single question or screening tools at different time points in patients hospitalized after admission to the hospital after significant physical trauma, but with stable vitals (level II trauma).
Patients completed the 'initial question' and the National Stressful Events Survey Acute Stress Disorder Scale (NSESSS) at 3 days to 5 days after trauma (NSESSS-1). The same scale was administered 2 weeks to 4 weeks after trauma (NSESSS-2). The Posttraumatic Stress Disorder Symptoms Scale Interview for DSM-5 (PSSI-5) was administered 2 months after trauma. PTSD diagnosis and PTSD severity were extracted from the PSSI-5. Linear multivariate regression analyses were used to establish whether scores for NSESSS-1 or NSESSS-2 predicted PTSD diagnosis/PTSD severity. Non-linear multivariate regression analyses were performed to better understand the relationship between NSESSS-1/NSESSS-2 and PTSD diagnosis/PTSD severity.
A single question assessing the experience of fear, helplessness, or horror was not an effective tool for determining the diagnosis of PTSD (p=0.114) but can be a predictor of PTSD severity (p=0.039). We demonstrate that administering the NSESSS after either 3 days to 5 days (p=0.008, p<0.001) or 2 weeks to 4 weeks (p=0.039; p<0.001) can predict the diagnosis of PTSD and PTSD severity. Scoring an NSESSS above 14/28 (50%) increases the chance of experiencing a higher PTSD severity substantially and linearly.
Our initial question was not an effective predictor of PTSD diagnosis. However, using the NSESSS at both 3 days to 5 days and 2 weeks to 4 weeks after trauma is an effective method for predicting PTSD diagnosis and PTSD severity. Additionally, we show that patients who score higher than 14 on the NSESSS for acute stress symptoms may need closer follow-up.
Level III, prognostic.
创伤后应激障碍（PTSD）会导致严重的精神和医学后果。本研究的目的是确定在因重大身体创伤入院后生命体征稳定（二级创伤）的住院患者中，通过在不同时间点使用单个问题或筛查工具评估创伤时经历，是否可以预测PTSD诊断和PTSD症状量表评分（PTSD严重程度）。
患者在创伤后3天至5天完成“初始问题”和《国家应激事件调查急性应激障碍量表》（NSESSS）（NSESSS-1）。在创伤后2周至4周施用相同量表（NSESSS-2）。在创伤后2个月施用《DSM-5创伤后应激障碍症状量表访谈》（PSSI-5）。从PSSI-5中提取PTSD诊断和PTSD严重程度。使用线性多变量回归分析确定NSESSS-1或NSESSS-2评分是否可预测PTSD诊断/PTSD严重程度。进行非线性多变量回归分析以更好地理解NSESSS-1/NSESSS-2与PTSD诊断/PTSD严重程度之间的关系。
一个评估恐惧、无助或恐怖经历的单一问题不是确定PTSD诊断的有效工具（p = 0.114），但可以作为PTSD严重程度的预测指标（p = 0.039）。我们证明，在创伤后3天至5天（p = 0.008，p < 0.001）或2周至4周（p = 0.039；p < 0.001）施用NSESSS可以预测PTSD诊断和PTSD严重程度。NSESSS得分高于14/28（50%）会大幅且线性增加经历更高PTSD严重程度的可能性。
我们的初始问题不是PTSD诊断的有效预测指标。然而，在创伤后3天至5天和2周至4周使用NSESSS是预测PTSD诊断和PTSD严重程度的有效方法。此外，我们表明，急性应激症状NSESSS得分高于14的患者可能需要更密切的随访。
三级，预后性。
