Six-month follow-up of the injured trauma survivor screen: Clinical implications and future directions

Joshua C. Hunt, Samantha A. Chesney, Karen Brasel, Terri A. Deroon-Cassini

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND The injured trauma survivor screen (ITSS) has been shown to predict posttraumatic stress disorder (PTSD) and depression risk at 1 month after traumatic injury. This study explored the ability of the ITSS to predict chronic distress after injury, as well as the impact of combining the ITSS with an additional screening measure. METHODS Patients were enrolled following admission to a Level I trauma center. Baseline measurements were collected during initial hospitalization, and follow-up measures were collected an average of 6.5 months after injury. Receiver operating characteristic (ROC) curve analyses were run to determine predictive accuracy, controlling for participants who had mental health intervention and for those who experienced additional potentially psychologically traumatic events since their injury event. RESULTS Utilizing a cut score of 2, the ITSS PTSD scale had a sensitivity of 85.42%, specificity of 67.35%, negative predictive value (NPV) of 91.9% and positive predictive value (PPV) of 51.4%. The combined PTSD risk group (risk positive on the baseline ITSS and the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) had a sensitivity of 72.92%, specificity of 81.63%, NPV of 88.2%, and PPV of 61.6%. Also using a cut score of 2, the ITSS Depression Scale had a sensitivity of 72.50%, specificity of 70.29%, NPV of 91.1%, and PPV of 37.9%. CONCLUSION The nine-item ITSS, which takes approximately 5 minutes to administer, is a stable screening tool for predicting those most at risk for PTSD and/or depression 6 months after admission to a Level I trauma center following traumatic injury. The combined PTSD risk group data provide evidence that symptom evaluation by a psychologist can improve specificity. These results further inform the recommendation of the American College of Surgeons Committee on Trauma regarding PTSD and depression screening in trauma centers. LEVEL OF EVIDENCE Prognostic study, level III.

Original languageEnglish (US)
Pages (from-to)263-270
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume85
Issue number2
DOIs
StatePublished - Aug 1 2018

Fingerprint

Survivors
Post-Traumatic Stress Disorders
Wounds and Injuries
Trauma Centers
Depression
Sensitivity and Specificity
Direction compound
Aptitude
Symptom Assessment
Checklist
ROC Curve
Diagnostic and Statistical Manual of Mental Disorders
Mental Health
Hospitalization
Psychology

Keywords

  • depression
  • PTSD
  • screen
  • trauma centers
  • traumatic injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Six-month follow-up of the injured trauma survivor screen : Clinical implications and future directions. / Hunt, Joshua C.; Chesney, Samantha A.; Brasel, Karen; Deroon-Cassini, Terri A.

In: Journal of Trauma and Acute Care Surgery, Vol. 85, No. 2, 01.08.2018, p. 263-270.

Research output: Contribution to journalArticle

Hunt, Joshua C. ; Chesney, Samantha A. ; Brasel, Karen ; Deroon-Cassini, Terri A. / Six-month follow-up of the injured trauma survivor screen : Clinical implications and future directions. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 85, No. 2. pp. 263-270.
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abstract = "BACKGROUND The injured trauma survivor screen (ITSS) has been shown to predict posttraumatic stress disorder (PTSD) and depression risk at 1 month after traumatic injury. This study explored the ability of the ITSS to predict chronic distress after injury, as well as the impact of combining the ITSS with an additional screening measure. METHODS Patients were enrolled following admission to a Level I trauma center. Baseline measurements were collected during initial hospitalization, and follow-up measures were collected an average of 6.5 months after injury. Receiver operating characteristic (ROC) curve analyses were run to determine predictive accuracy, controlling for participants who had mental health intervention and for those who experienced additional potentially psychologically traumatic events since their injury event. RESULTS Utilizing a cut score of 2, the ITSS PTSD scale had a sensitivity of 85.42{\%}, specificity of 67.35{\%}, negative predictive value (NPV) of 91.9{\%} and positive predictive value (PPV) of 51.4{\%}. The combined PTSD risk group (risk positive on the baseline ITSS and the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) had a sensitivity of 72.92{\%}, specificity of 81.63{\%}, NPV of 88.2{\%}, and PPV of 61.6{\%}. Also using a cut score of 2, the ITSS Depression Scale had a sensitivity of 72.50{\%}, specificity of 70.29{\%}, NPV of 91.1{\%}, and PPV of 37.9{\%}. CONCLUSION The nine-item ITSS, which takes approximately 5 minutes to administer, is a stable screening tool for predicting those most at risk for PTSD and/or depression 6 months after admission to a Level I trauma center following traumatic injury. The combined PTSD risk group data provide evidence that symptom evaluation by a psychologist can improve specificity. These results further inform the recommendation of the American College of Surgeons Committee on Trauma regarding PTSD and depression screening in trauma centers. LEVEL OF EVIDENCE Prognostic study, level III.",
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N2 - BACKGROUND The injured trauma survivor screen (ITSS) has been shown to predict posttraumatic stress disorder (PTSD) and depression risk at 1 month after traumatic injury. This study explored the ability of the ITSS to predict chronic distress after injury, as well as the impact of combining the ITSS with an additional screening measure. METHODS Patients were enrolled following admission to a Level I trauma center. Baseline measurements were collected during initial hospitalization, and follow-up measures were collected an average of 6.5 months after injury. Receiver operating characteristic (ROC) curve analyses were run to determine predictive accuracy, controlling for participants who had mental health intervention and for those who experienced additional potentially psychologically traumatic events since their injury event. RESULTS Utilizing a cut score of 2, the ITSS PTSD scale had a sensitivity of 85.42%, specificity of 67.35%, negative predictive value (NPV) of 91.9% and positive predictive value (PPV) of 51.4%. The combined PTSD risk group (risk positive on the baseline ITSS and the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) had a sensitivity of 72.92%, specificity of 81.63%, NPV of 88.2%, and PPV of 61.6%. Also using a cut score of 2, the ITSS Depression Scale had a sensitivity of 72.50%, specificity of 70.29%, NPV of 91.1%, and PPV of 37.9%. CONCLUSION The nine-item ITSS, which takes approximately 5 minutes to administer, is a stable screening tool for predicting those most at risk for PTSD and/or depression 6 months after admission to a Level I trauma center following traumatic injury. The combined PTSD risk group data provide evidence that symptom evaluation by a psychologist can improve specificity. These results further inform the recommendation of the American College of Surgeons Committee on Trauma regarding PTSD and depression screening in trauma centers. LEVEL OF EVIDENCE Prognostic study, level III.

AB - BACKGROUND The injured trauma survivor screen (ITSS) has been shown to predict posttraumatic stress disorder (PTSD) and depression risk at 1 month after traumatic injury. This study explored the ability of the ITSS to predict chronic distress after injury, as well as the impact of combining the ITSS with an additional screening measure. METHODS Patients were enrolled following admission to a Level I trauma center. Baseline measurements were collected during initial hospitalization, and follow-up measures were collected an average of 6.5 months after injury. Receiver operating characteristic (ROC) curve analyses were run to determine predictive accuracy, controlling for participants who had mental health intervention and for those who experienced additional potentially psychologically traumatic events since their injury event. RESULTS Utilizing a cut score of 2, the ITSS PTSD scale had a sensitivity of 85.42%, specificity of 67.35%, negative predictive value (NPV) of 91.9% and positive predictive value (PPV) of 51.4%. The combined PTSD risk group (risk positive on the baseline ITSS and the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) had a sensitivity of 72.92%, specificity of 81.63%, NPV of 88.2%, and PPV of 61.6%. Also using a cut score of 2, the ITSS Depression Scale had a sensitivity of 72.50%, specificity of 70.29%, NPV of 91.1%, and PPV of 37.9%. CONCLUSION The nine-item ITSS, which takes approximately 5 minutes to administer, is a stable screening tool for predicting those most at risk for PTSD and/or depression 6 months after admission to a Level I trauma center following traumatic injury. The combined PTSD risk group data provide evidence that symptom evaluation by a psychologist can improve specificity. These results further inform the recommendation of the American College of Surgeons Committee on Trauma regarding PTSD and depression screening in trauma centers. LEVEL OF EVIDENCE Prognostic study, level III.

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