Screening for Risk of Persistent Posttraumatic Stress in Injured Children and Their Parents

The Children's Hospital of Philadelphia, Filadelfia, Pennsylvania, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/2003; 290(5):643-9. DOI: 10.1001/jama.290.5.643
Source: PubMed


Injury, a leading health threat to children, is also a common cause of posttraumatic stress disorder (PTSD) in childhood. Most injured children with PTSD are not diagnosed or treated.
To develop a stand-alone screening tool for use by clinicians during acute trauma care to identify injured children and their parents who are at risk of significant, persistent posttraumatic stress symptoms.
The Screening Tool for Early Predictors of PTSD (STEPP) was derived from a 50-item risk factor survey administered within 1 month of injury as part of a prospective cohort study of posttraumatic stress in injured children and their parents. Symptoms of PTSD were assessed at least 3 months after injury.
Urban, pediatric level I trauma center.
A sample of 269 children aged 8 to 17 years admitted for treatment of traffic-related injuries between July 1999 and October 2001, and one parent per child, completed a risk factor survey assessing potential predictors of PTSD outcome. One hundred seventy-one families (63%) completed a follow-up assessment.
The Clinician-Administered PTSD Scale for Children and Adolescents and the PTSD Checklist served as criterion standards for child and parent outcomes, respectively. Positive cases were defined as those meeting criteria for at least subsyndromal PTSD with continuing impairment ("persistent traumatic stress").
The STEPP contains 4 dichotomous questions asked of the child, 4 asked of one parent, and 4 items obtained easily from the emergency medical record. STEPP sensitivity in predicting posttraumatic stress was 0.88 for children and 0.96 for parents, with negative predictive values of 0.95 for children and 0.99 for parents. The odds ratio for prediction of persistent traumatic stress was 6.5 (95% confidence interval [CI], 1.8-22.8) in children and 26.6 (95% CI, 3.5-202.1) in parents.
The STEPP represents a new method to guide clinicians in making evidence-based decisions for the allocation of scarce mental health resources for traumatic stress. Its brevity and simple scoring rule suggest that it can be easily administered in the acute care setting.

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    • "A number of brief PTSD screening tools are available, including the Primary Care PTSD Screener (PCPS), the Short Screening Scale for PTSD (SSSP), the Abbreviated PTSD Checklist (APCL), and the Short PTSD Rating Interview (SPRINT), among others (Breslau et al., 1999b; Winston et al., 2003; Brewin, 2005; Lang and Stein, 2005; Norris et al., 2006; Bliese et al., 2008; Calhoun et al., 2010). These instruments are relatively short, have been shown to have reasonable specificity and sensitivity, and are focused on screening for core PTSD symptoms. "
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    ABSTRACT: We previously developed a new posttraumatic stress disorder (PTSD) screening instrument-the New York PTSD Risk Score (NYPRS). Since research suggests different PTSD risk factors and outcomes for men and women, in the current study we assessed the suitability of male and female versions of this screening instrument among 3298 adults exposed to traumatic events. Using diagnostic test methods, including receiver operating characteristic (ROC) curve and bootstrap techniques, we examined different prediction domains, including core PTSD symptoms, trauma exposures, sleep disturbances, depression symptoms, and other measures to assess PTSD prediction models for men and women. While the original NYPRS worked well in predicting PTSD, significant interaction was detected by gender, suggesting that separate models are warranted for men and women. Model comparisons suggested that while the overall results appeared robust, prediction results differed by gender. For example, for women, core PTSD symptoms contributed more to the prediction score than for men. For men, depression symptoms, sleep disturbance, and trauma exposure contributed more to the prediction score. Men also had higher cut-off scores for PTSD compared to women. There were other gender-specific differences as well. The NYPRS is a screener that appears to be effective in predicting PTSD status among at-risk populations. However, consistent with other medical research, this instrument appears to require male and female versions to be the most effective.
    Psychiatry Research 05/2012; 200(2-3). DOI:10.1016/j.psychres.2012.04.022 · 2.47 Impact Factor
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    • "To date, a number of brief PTSD screening tools are available. These screeners include the Primary Care PTSD Screen (PCPS), the Short Screening Scale for PTSD (SSSP), the abbreviated PTSD Checklist, the Short PTSD Rating Interview and the Screening Tool for Early Prediction of PTSD (STEPP), among others [17] [18] [19] [20] [21] [22] [23] [24] [25]. With the exception of the STEPP scale, which was designed for children and parents, these screening scales were developed for adult populations. "
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    ABSTRACT: The objective was to develop a brief posttraumatic stress disorder (PTSD) screening instrument that is useful in clinical practice, similar to the Framingham Risk Score used in cardiovascular medicine. We used data collected in New York City after the World Trade Center disaster (WTCD) and other trauma data to develop a new PTSD prediction tool--the New York PTSD Risk Score. We used diagnostic test methods to examine different clinical domains, including PTSD symptoms, trauma exposures, sleep disturbances, suicidal thoughts, depression symptoms, demographic factors and other measures to assess different PTSD prediction models. Using receiver operating curve (ROC) and bootstrap methods, five prediction domains, including core PTSD symptoms, sleep disturbance, access to care status, depression symptoms and trauma history, and five demographic variables, including gender, age, education, race and ethnicity, were identified. For the best prediction model, the area under the ROC curve (AUC) was 0.880 for the Primary Care PTSD Screen alone (specificity=82.2%, sensitivity=93.7%). Adding care status, sleep disturbance, depression and trauma exposure increased the AUC to 0.943 (specificity=85.7%, sensitivity=93.1%), a significant ROC improvement (P<.0001). Adding demographic variables increased the AUC to 0.945, which was not significant (P=.250). To externally validate these models, we applied the WTCD results to 705 pain patients treated at a multispecialty group practice and to 225 trauma patients treated at a Level I Trauma Center. These results validated those from the original WTCD development and validation samples. The New York PTSD Risk Score is a multifactor prediction tool that includes the Primary Care PTSD Screen, depression symptoms, access to care, sleep disturbance, trauma history and demographic variables and appears to be effective in predicting PTSD among patients seen in healthcare settings. This prediction tool is simple to administer and appears to outperform other screening measures.
    General hospital psychiatry 07/2011; 33(5):489-500. DOI:10.1016/j.genhosppsych.2011.06.001 · 2.61 Impact Factor
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    • "Although the current findings add to a growing literature demonstrating it is possible to develop screening instruments for childhood posttraumatic stress, whether these screens can be effectively used in hospital settings by clinical (as opposed to research) staff needs to be demonstrated. Given that there is a universal push in hospitals for quick discharge of patients, and that studies have screened children both during and after hospitalization (e.g., the present study, as well as Kenardy et al., 2006, and Winston et al., 2003), the practical issue of who would undertake such screenings after discharge is a potentially important barrier. One possibility is that parents are given information that would allow this to occur via a website so that parents can make contact with a list of referral agencies (provided at discharge ) if concerned. "
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    ABSTRACT: Three screening methods to predict posttraumatic stress disorder (PTSD) and depression symptoms in children following single-incident trauma were tested. Children and adolescents (N = 90; aged 7-17 years) were assessed within 4 weeks of an injury that led to hospital treatment and followed up 3 and 6 months later. Screening methods were adapted from existing instruments and examined (a) an Australian version of the Screening Tool for Predictors of PTSD (STEPP-AUS), (b) an abbreviated measure of initial PTSD severity, and (c) an abbreviated measure of initial maladaptive trauma-specific beliefs. The STEPP-AUS correctly identified 89% of the children who developed PTSD at 6-month follow-up and the 69% of children who were non-PTSD. Predictive performance of the others instruments was generally poor, and no instrument consistently predicted subclinical levels of depression.
    Journal of Clinical Child & Adolescent Psychology 06/2010; 39(4):588-96. DOI:10.1080/15374416.2010.486322 · 1.92 Impact Factor
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