Efficiency of a four-item posttraumatic stress disorder screen in trauma patients

BACKGROUND: One of the most common barriers identified by physicians who fail to screen for posttraumatic stress disorder (PTSD) in trauma patients is time constraint. We hypothesized the four-question Primary Care-PTSD screen (PC-PTSD) was an acceptable alternative to the commonly used 17-question Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C). METHODS: Consecutive trauma patients admitted to a Level I trauma center were given the PCL-C at the time of hospitalization. The four questions of the PC-PTSD are contained within the PCL-C. A positive PC-PTSD screen result was an endorsement of least three of the four questions. An overall score of greater than 44 on the PCL-C indicated a positive screen result. Sensitivity and specificity comparisons were made between the PCL-C and the PC-PTSD. RESULTS: Data were collected from 1,347 patients hospitalized for injury. The PC-PTSD identified 17.22% of patients with PTSD risk, and the PCL-C identified 16.10% at risk. Before discharge, the PC-PTSD has reasonable sensitivity in capturing the population at risk PTSD symptoms. CONCLUSION: In trauma patients before hospital discharge, the PC-PTSD is comparable with the PCL-C. Although some sensitivity is lost,the PC-PTSD is a shorter screen, and the loss of sensitivity may be offset by an increased frequency of administration.