Six-month Follow Up of the Injured Trauma Survivor Screen (ITSS): Clinical Implications and Future Directions

Background The Injured Trauma Survivor Screen (ITSS) has been shown to predict PTSD and depression risk at one-month after traumatic injury. This study explored the ability of the ITSS to predict chronic distress after injury, as well as the impact of combining the ITSS with an additional screening measure. Method Patients were enrolled following admission to a Level 1 trauma center. Baseline measurements were collected during initial hospitalization, and follow-up measures were collected an average of 6.5 months after injury. Receiver Operating Characteristic (ROC) curve analyses were run to determine predictive accuracy, controlling for participants who had mental health intervention and for those who experienced additional potentially psychologically traumatic events since their injury event. Results Utilizing a cut score of 2, the ITSS PTSD scale had a sensitivity of 85.42%, specificity 67.35%, NPV 91.9% and PPV 51.4%. The Combined PTSD risk group (risk positive on the baseline ITSS and the PTSD Checklist for the DSM-5) had a sensitivity of 72.92%, specificity 81.63%, NPV 88.2% and PPV 61.6%. Also utilizing a cut score of 2, the ITSS Depression scale had a sensitivity of 72.50%, specificity 70.29%, NPV 91.1% and PPV 37.9%. Conclusions The 9-item ITSS, which takes approximately five minutes to administer, is a stable screening tool for predicting those most at risk for PTSD and/or depression six-months after admission to a Level 1 trauma center following traumatic injury. The Combined PTSD risk group data provide evidence that symptom evaluation by a psychologist can improve specificity. These results further inform the recommendation of the American College of Surgeons Committee on Trauma regarding PTSD and depression screening in trauma centers. Level of Evidence Prognostic study, Level III. Corresponding Author: Joshua C. Hunt, Ph.D., Medical College of Wisconsin, 9200 West Wisconsin Ave., Milwaukee, WI 53226. 414-805-8641. Fax: 414-805-8641. jhunt@mcw.edu The authors have no conflicts of interest to report. Funded in part byNIH grant, 1 R21 MH 102838-01 A1 76th Annual Meeting of AAST and Clinical Congress of Acute Care Surgery, September 13-16, 2017, in Baltimore, MD © 2018 Lippincott Williams & Wilkins, Inc.

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