Test Accuracy of the Screening Tool for Early Predictors of Post-traumatic Stress Disorder for Post-injury Mental Health in a Managed-Medicaid Population

Abstract

To determine the Screening Tool for Early Predictors of Post-Traumatic Stress Disorder (STEPP) test accuracy in identifying children with new mental health diagnoses and psychotropic medications prescribed within 12months after unintentional injuries in a managed-Medicaid population. We conducted a secondary analysis of a retrospective cohort that investigated mental health diagnoses and psychotropic medications pre- and post-injury in children ≤18years of age treated at a pediatric trauma center from 2005 to 2015 (n=2208). For this study, we analyzed children with STEPP scores from their injury admission (n=85). For children without previous mental health diagnoses or psychotropic prescriptions, we calculated the sensitivity, specificity, and positive and negative predictive values for the child and parent STEPP. Of 78 children without previous diagnoses, 12 had post-injury mental health diagnoses. Of 68 children without previous psychotropic medication use, 10 had psychotropic medications prescribed. The child STEPP sensitivity was 8.3% for mental health diagnoses (95% CI 0.2, 38.5) and 10% for psychotropic medications (95% CI 0.3, 44.5). The child STEPP specificity was 77.3% for mental health diagnoses (95% CI 65.3, 86.7) and 75.9% for psychotropic medication (95% CI 62.8, 86.1). We found that the STEPP performed poorly in identifying children who received new mental health diagnoses and new psychotropic medications following injury.