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01.12.2014 | Research | Ausgabe 1/2014 Open Access

Journal of Trauma Management & Outcomes 1/2014

Routine versus ad hoc screening for acute stress following injury: who would benefit and what are the opportunities for prevention

Zeitschrift:
Journal of Trauma Management & Outcomes > Ausgabe 1/2014
Autoren:
Nathaniel Bell, Boris Sobolev, Stephen Anderson, Robert Hewko, Richard K Simons
Wichtige Hinweise

Competing interests

There are no competing interests among any of the authors.

Authors’ contributions

Conception and design: NB and RKS. Acquisition of data: NB. Analysis and interpretation of data: NB, RKS, BS, SA, RH. Drafting of manuscript: NB, RKS, BS, SA. Study supervision: RKS and BS. All authors read and approved the final manuscript.

Abstract

Background

Screening for acute stress is not part of routine trauma care owing in part to high variability of acute stress symptoms in identifying later onset of posttraumatic stress disorder (PTSD). The objective of this pilot study was to assess the sensitivity, specificity, and power to predict onset of PTSD symptoms at 1 and 4 months using a routine screening program in comparison to current ad hoc referral practice.

Methods

Prospective cross-sectional observational study of a sample of hospitalized trauma patients over a four-month period from a level-I hospital in Canada. Baseline assessments of acute stress (ASD) and subsyndromal ASD (SASD) were measured using the Stanford Acute Stress Reaction Questionnaire (SASRQ). In-hospital psychiatric consultations were identified from patient discharge summaries. PTSD symptoms were measured using the PTSD Checklist-Specific (PCL-S). Post-discharge health status and health services utilization surveys were also collected.

Results

Routine screening using the ASD (0.43) and SASD (0.64) diagnoses were more sensitive to PTSD symptoms at one 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 greater positive predictive power in identifying PTSD caseness at 1 month (0.50) in comparison to the ASD (0.46) and SASD (0.43) diagnoses and also at 4 months (0.67 versus 0.25 and 0.29).

Conclusions

Ad hoc psychiatric referral process for acute stress is a more conservative approach than employing routine screening for identifying persons who are at risk of psychological morbidity following injury. Despite known limitations of available measures, routine patient screening would increase identification of trauma survivors at risk of mental health sequelae and better position trauma centers to respond to the circumstances that affect mental health during recovery.
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