Efficiency of a four-item posttraumatic stress disorder screen in trauma patients

Abstract

One of the most common barriers identified by physicians who fail to screen for posttraumatic stress disorder (PTSD) in trauma patients is time constraint. We hypothesized the four-question Primary Care-PTSD screen (PC-PTSD) was an acceptable alternative to the commonly used 17-question Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C). Consecutive trauma patients admitted to a Level I trauma center were given the PCL-C at the time of hospitalization. The four questions of the PC-PTSD are contained within the PCL-C. A positive PC-PTSD screen result was an endorsement of least three of the four questions. An overall score of greater than 44 on the PCL-C indicated a positive screen result. Sensitivity and specificity comparisons were made between the PCL-C and the PC-PTSD. Data were collected from 1,347 patients hospitalized for injury. The PC-PTSD identified 17.22% of patients with PTSD risk, and the PCL-C identified 16.10% at risk. Before discharge, the PC-PTSD has reasonable sensitivity in capturing the population at risk PTSD symptoms. In trauma patients before hospital discharge, the PC-PTSD is comparable with the PCL-C. Although some sensitivity is lost,the PC-PTSD is a shorter screen, and the loss of sensitivity may be offset by an increased frequency of administration. Diagnostic test, level III.