Derivation and Validation of a Brief Emergency Department-Based Prediction Tool for Posttraumatic Stress After Motor Vehicle Collision.
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Jones Christopher W, An Xinming, Ji Yinyao, Liu Mochuan, Zeng Donglin, House Stacey L, Beaudoin Francesca L, Stevens Jennifer S, Neylan Thomas C, Clifford Gari D, Jovanovic Tanja, Linnstaedt Sarah D, Germine Laura T, Bollen Kenneth A, Rauch Scott L, Haran John P, Storrow Alan B, Lewandowski Christopher, Musey Paul I, Hendry Phyllis L, Sheikh Sophia, Punches Brittany E, Lyons Michael S, Kurz Michael C, Swor Robert A, McGrath Meghan E, Hudak Lauren A, Pascual Jose L, Seamon Mark J, Datner Elizabeth M, Harris Erica, Chang Anna M, Pearson Claire, Peak David A, Merchant Roland C, Domeier Robert M, Rathlev Niels K, O'Neil Brian J, Sergot Paulina, Sanchez Leon D, Bruce Steven E, Miller Mark W, Pietrzak Robert H, Joormann Jutta, Barch Deanna M, Pizzagalli Diego A, Sheridan John F, Smoller Jordan W, Harte Steven E, Elliott James M, Koenen Karestan C, Ressler Kerry J, Kessler Ronald C, McLean Samuel A
Аннотация
METHODS: Derivation (n=1,282, 19 ED sites) and validation (n=282, 11 separate ED sites) data were obtained from adults prospectively enrolled in the Advancing Understanding of RecOvery afteR traumA study who were discharged from the ED after motor vehicle collision-related trauma. The primary outcome was substantial posttraumatic stress symptoms at 3 months (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5 ≥38). Logistic regression derivation models were evaluated for discriminative ability using the area under the curve and the accuracy of predicted risk probabilities (Brier score). Candidate posttraumatic stress predictors assessed in these models (n=265) spanned a range of sociodemographic, baseline health, peritraumatic, and mechanistic domains. The final model selection was based on performance and ease of administration.
RESULTS: Significant 3-month posttraumatic stress symptoms were common in the derivation (27%) and validation (26%) cohort. The area under the curve and Brier score of the final 8-question tool were 0.82 and 0.14 in the derivation cohort and 0.76 and 0.17 in the validation cohort.
CONCLUSION: This simple 8-question tool demonstrates promise to risk-stratify individuals with substantial posttraumatic stress symptoms who are discharged to home after a motor vehicle collision. Both external validation of this instrument, and work to further develop more accurate tools, are needed. Such tools might benefit public health by enabling the conduct of preventive intervention trials and assisting the growing number of EDs that provide services to trauma survivors aimed at promoting psychological recovery.