Predicting Post Traumatic Stress Disorder from Acute Stress Disorder in Burn Injured Patients: A Longitudinal Study

Abstract

Recent literature on the relationship between Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder (PTSD) has focused on prediction, with the end goal being the prevention of subsequent development of PTSD. This paper contributes to this direction by studying a population of burn patients using established self-report measures of ASD and PTSD. A total of 247 hospitalized patients > 18 years of age with major burns based on ABA criteria participated in this longitudinal outcome study. The participants completed the Stanford Acute Stress Reaction Questionnaire (SASRQ) or Acute Stress Disorder Scale (ASDS) at discharge, and the Davidson Trauma Scale (DTS) at 1 month, 6 months, 1 year, and 2 years post-discharge. The prevalence of ASD, as measured by the SASRQ, was 22.2% and by the ASDS was 32.3%. Similarly, the prevalence rates of PTSD using the DTS at 1 month, 6 months, 1 year, and 2 years post-discharge were 32.9%, 28.6%, 24.7%, and 25.8% using the standard cutoff score of > 40. Further, the “lifetime” post-burn prevalence rate of PTSD was 39.7%. For both the SASRQ and the ASDS, the diagnostic criteria approach and the cutoff score approach (based on the total score) were used and compared to determine which method provided better prediction of subsequent PTSD on the DTS. The cutoff score approach (using cutoffs of > 35 for both the SASRQ and ASDS) yielded better results for all time periods; the results are summarized in Table 1. The corresponding results for the diagnostic criteria were moderate to high specificity ratios for the SASRQ (0.90–0.93) and ASDS (0.60–0.72), but low to moderate sensitivity ratios for both the SASRQ (0.36–0.46) and the ASDS (0.20–0.67).