Background: Screening for acute stress is not part of routine trauma care owing in part to high variability of acute\nstress symptoms in identifying later onset of posttraumatic stress disorder (PTSD). The objective of this pilot study\nwas to assess the sensitivity, specificity, and power to predict onset of PTSD symptoms at 1 and 4 months using a\nroutine screening program in comparison to current ad hoc referral practice.\nMethods: Prospective cross-sectional observational study of a sample of hospitalized trauma patients over a\nfour-month period from a level-I hospital in Canada. Baseline assessments of acute stress (ASD) and subsyndromal\nASD (SASD) were measured using the Stanford Acute Stress Reaction Questionnaire (SASRQ). In-hospital psychiatric\nconsultations were identified from patient discharge summaries. PTSD symptoms were measured using the PTSD\nChecklist-Specific (PCL-S). Post-discharge health status and health services utilization surveys were also collected.\nResults: Routine screening using the ASD (0.43) and SASD (0.64) diagnoses were more sensitive to PTSD symptoms at\none month in comparison to ad hoc referral (0.14) and also at four months (0.17, 0.33 versus 0.17). Ad hoc referral had\ngreater positive predictive power in identifying PTSD caseness at 1 month (0.50) in comparison to the ASD (0.46) and\nSASD (0.43) diagnoses and also at 4 months (0.67 versus 0.25 and 0.29).\nConclusions: Ad hoc psychiatric referral process for acute stress is a more conservative approach than employing\nroutine screening for identifying persons who are at risk of psychological morbidity following injury. Despite known\nlimitations of available measures, routine patient screening would increase identification of trauma survivors at risk of\nmental health sequelae and better position trauma centers to respond to the circumstances that affect mental health\nduring recovery.
Loading....