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. 2020 Mar 2;20(1):16.
doi: 10.1186/s12873-020-00308-z.

Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study

Willem F van der Mei  1 , Anna C Barbano  2 , Andrew Ratanatharathorn  3 , Richard A Bryant  4 , Douglas L Delahanty  5 , Terri A deRoon-Cassini  6 , Betty S Lai  7 , Sarah R Lowe  8 , Yutaka J Matsuoka  9 , Miranda Olff  10   11 , Wei Qi  2 , Ulrich Schnyder  12 , Soraya Seedat  13 , Ronald C Kessler  14 , Karestan C Koenen  15 , Arieh Y Shalev  2 ; International Consortium to Predict PTSD
Collaborators, Affiliations

Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study

Willem F van der Mei et al. BMC Emerg Med. .

Erratum in

Abstract

Background: Previous work has indicated that post-traumatic stress disorder (PTSD) symptoms, measured by the Clinician-Administered PTSD Scale (CAPS) within 60 days of trauma exposure, can reliably produce likelihood estimates of chronic PTSD among trauma survivors admitted to acute care centers. Administering the CAPS is burdensome, requires skilled professionals, and relies on symptoms that are not fully expressed upon acute care admission. Predicting chronic PTSD from peritraumatic responses, which are obtainable upon acute care admission, has yielded conflicting results, hence the rationale for a stepwise screening-and-prediction practice. This work explores the ability of peritraumatic responses to produce risk likelihood estimates of early CAPS-based PTSD symptoms indicative of chronic PTSD risk. It specifically evaluates the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) as a risk-likelihood estimator.

Methods: We used individual participant data (IPD) from five acute care studies that used both the PDEQ and the CAPS (n = 647). Logistic regression calculated the probability of having CAPS scores ≥ 40 between 30 and 60 days after trauma exposure across the range of initial PDEQ scores, and evaluated the added contribution of age, sex, trauma type, and prior trauma exposure. Brier scores, area under the receiver-operating characteristic curve (AUC), and the mean slope of the calibration line evaluated the accuracy and precision of the predicted probabilities.

Results: Twenty percent of the sample had CAPS ≥ 40. PDEQ severity significantly predicted having CAPS ≥ 40 symptoms (p < 0.001). Incremental PDEQ scores produced a reliable estimator of CAPS ≥ 40 likelihood. An individual risk estimation tool incorporating PDEQ and other significant risk indicators is provided.

Conclusion: Peritraumatic reactions, measured here by the PDEQ, can reliably quantify the likelihood of acute PTSD symptoms predictive of chronic PTSD and requiring clinical attention. Using them as a screener in a stepwise chronic PTSD prediction strategy may reduce the burden of later CAPS-based assessments. Other peritraumatic metrics may perform similarly and their use requires similar validation.

Trial registration: Jerusalem Trauma Outreach and Prevention Study (J-TOPS): NCT00146900.

Keywords: Emergency care admissions; Mega-analysis; Peritraumatic symptoms; Post-traumatic stress disorder; Sequential prediction.

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Conflict of interest statement

Dr. Matsuoka reports personal fees from Morinaga Milk, Eli Lilly, and NTT Data. Over the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis; was a consultant for Johnson & Johnson Wellness and Prevention, Sage Pharmaceuticals, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. Other authors report no potential conflict of interest.

Figures

Fig. 1
Fig. 1
Forest plot of log odds ratios between PDEQ Score and CAPS ≥ 40 for individual studies
See this image and copyright information in PMC

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