From the Department of Surgery (S.M.J.), Carolinas Medical Center, Atrium Health, Charlotte; University of North Carolina School of Medicine (I.A., M.B.), Chapel Hill; Department of Surgery (J.G.), University of North Carolina; and Department of Internal Medicine (C.F.), University of North Carolina, Chapel Hill, NC.
J Trauma Acute Care Surg. 2022 Jun 1;92(6):e115-e126. doi: 10.1097/TA.0000000000003524. Epub 2022 Jan 5.
Adult trauma patients are at risk of developing posttraumatic stress disorder (PTSD). Early intervention reduces the development of PTSD, but few trauma patients seek and obtain care. Valid and reliable screening tools are needed to identify patients at risk of developing PTSD. The objective of this review is to identify existing screening tools and evaluate their accuracy for predicting PTSD outcomes.
PubMed, PsychInfo, and ClinicalTrials.gov were searched for studies evaluating the predictive accuracy of PTSD screening tools among traumatically injured adult civilians. Eligible studies assessed patients during acute hospitalization and at least 1 month following injury to measure PTSD outcome. Eligible outcomes included measures of predictive accuracy, such as sensitivity and specificity. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias of each study, and the strength of evidence was assessed following the Agency for Healthcare Research and Quality guidelines.
Forty-nine studies were included evaluating the predictive accuracy of 38 screening tools. Most tools were assessed in a single study. Questionnaire-style tools had more favorable predictive ability than diagnostic interview assessments. The Injured Trauma Survivor Screen, Posttraumatic Adjustment Screen, the PTSD Checklist for DSM-5, and the Richmond et al. tool demonstrated the most favorable predictive accuracy, with high sensitivity (75-100%) and specificity (67-94%). Common sources of bias were selection bias due to high attrition rate and using nondiagnostic tools to assess PTSD symptoms at follow-up.
Although sensitivity and specificity of PTSD predictive tools varied widely, several emerged with favorable predictive accuracy. Further research is needed to define the ability of screening and intervention to prevent PTSD in injured trauma survivors. The results of this review can inform screening tool options for screening programs and future intervention studies.
Systematic review, level III.
成人创伤患者有发生创伤后应激障碍（PTSD）的风险。早期干预可降低 PTSD 的发生，但创伤患者寻求和获得治疗的比例很少。需要有效的、可靠的筛查工具来识别有发生 PTSD 风险的患者。本综述的目的是确定现有的筛查工具，并评估其预测 PTSD 结局的准确性。
在 PubMed、PsychInfo 和 ClinicalTrials.gov 中搜索评估 PTSD 筛查工具在创伤后成年平民中的预测准确性的研究。符合条件的研究在急性住院期间和受伤后至少 1 个月评估患者，以测量 PTSD 结局。符合条件的结局包括预测准确性的指标，如敏感度和特异度。采用诊断准确性研究 2 号工具评估每项研究的偏倚风险，并按照医疗保健研究和质量局的指南评估证据强度。
共纳入 49 项研究，评估了 38 种筛查工具的预测准确性。大多数工具仅在一项研究中进行了评估。问卷式工具的预测能力比诊断访谈评估更有利。受伤创伤幸存者筛查量表、创伤后适应筛查量表、DSM-5 创伤后清单和里士满等人的工具表现出最有利的预测准确性，具有较高的敏感度（75%-100%）和特异度（67%-94%）。常见的偏倚来源是由于高失访率导致的选择偏倚，以及在随访时使用非诊断性工具评估 PTSD 症状。
尽管 PTSD 预测工具的敏感度和特异度差异很大，但有几种工具具有较好的预测准确性。需要进一步研究来确定筛查和干预在预防受伤创伤幸存者 PTSD 方面的能力。本综述的结果可为筛查方案和未来干预研究的筛查工具选择提供信息。
系统综述，III 级。
