Abstract：
BACKGROUND: The American College of Surgeons Committee on Trauma (ACS-CoT) mandated that trauma centers have mental health screening and referral protocols in place by 2023. This study compares the Injured Trauma Survivor Screen (ITSS) and the Automated Electronic Medical Record (EMR) Screen to assess their performance in predicting risk for posttraumatic stress disorder (PTSD) within the same sample of trauma patients to inform trauma centers\' decision when selecting a tool to best fit their current clinical practice.
METHODS: This was a secondary analysis of three prospective cohort studies of traumatically injured patients (N = 255). The ITSS and Automated EMR Screen were compared using receiver operating characteristic curves to predict risk of subsequent PTSD development. PTSD diagnosis at 6-month follow-up was assessed using the Clinician Administered PTSD Scale for DSM-5.
RESULTS: Just over half the sample screened positive on the ITSS (57.7%), while 67.8% screened positive on the Automated EMR Screen. The area under the curve (AUC) for the two screens was not significantly different (ITSS AUC = 0.745 versus Automated EMR Screen AUC = 0.694, p = 0.21), similar performance in PTSD risk predication within the same general trauma population. The ITSS and Automated EMR Screen had similar sensitivities (86.5%, 89.2%), and specificities (52.5%, 40.9%) respectively at their recommended cut-off points.
CONCLUSIONS: Both screens are psychometrically comparable. Therefore, trauma centers considering screening tools for PTSD risk to comply with the ACS-CoT 2023 mandate should consider their local resources and patient population. Regardless of screen selection, screening must be accompanied by a referral process to address the identified risk.
METHODS: This was a secondary analysis of three prospective cohort studies of traumatically injured patients (N = 255). The ITSS and Automated EMR Screen were compared using receiver operating characteristic curves to predict risk of subsequent PTSD development. PTSD diagnosis at 6-month follow-up was assessed using the Clinician Administered PTSD Scale for DSM-5.
RESULTS: Just over half the sample screened positive on the ITSS (57.7%), while 67.8% screened positive on the Automated EMR Screen. The area under the curve (AUC) for the two screens was not significantly different (ITSS AUC = 0.745 versus Automated EMR Screen AUC = 0.694, p = 0.21), similar performance in PTSD risk predication within the same general trauma population. The ITSS and Automated EMR Screen had similar sensitivities (86.5%, 89.2%), and specificities (52.5%, 40.9%) respectively at their recommended cut-off points.
CONCLUSIONS: Both screens are psychometrically comparable. Therefore, trauma centers considering screening tools for PTSD risk to comply with the ACS-CoT 2023 mandate should consider their local resources and patient population. Regardless of screen selection, screening must be accompanied by a referral process to address the identified risk.
摘要：
背景：美国外科医生协会创伤委员会（ACS-CoT）要求创伤中心在2023年之前制定心理健康筛查和转诊方案。这项研究比较了创伤幸存者屏幕（ITSS）和自动电子医疗记录（EMR）屏幕，以评估它们在预测同一创伤患者样本中的创伤后应激障碍（PTSD）风险方面的表现，以告知创伤中心选择最适合其当前临床实践的工具时的决定。
方法：这是对三个创伤患者（N=255）的前瞻性队列研究的二次分析。使用受试者工作特征曲线比较了ITSS和自动EMR屏幕，以预测随后发生PTSD的风险。使用DSM-5的临床医生管理的PTSD量表评估6个月随访时的PTSD诊断。
结果：超过一半的样本在ITSS上呈阳性（57.7％），而67.8%的人在自动EMR屏幕上呈阳性。两个屏幕的曲线下面积（AUC）没有显着差异（ITSSAUC=0.745与自动EMR屏幕AUC=0.694，p=0.21），在相同的一般创伤人群中，PTSD风险预测表现相似。ITSS和自动EMR屏幕具有相似的灵敏度(86.5%，89.2%)，和特异性(52.5%，40.9%）分别在其建议的临界点。
结论：两种屏幕在心理测量上具有可比性。因此,创伤中心考虑使用符合ACS-CoT2023任务的PTSD风险筛查工具,应考虑其当地资源和患者人群.无论屏幕选择如何，筛查必须伴随转诊流程,以解决已识别的风险.
方法：这是对三个创伤患者（N=255）的前瞻性队列研究的二次分析。使用受试者工作特征曲线比较了ITSS和自动EMR屏幕，以预测随后发生PTSD的风险。使用DSM-5的临床医生管理的PTSD量表评估6个月随访时的PTSD诊断。
结果：超过一半的样本在ITSS上呈阳性（57.7％），而67.8%的人在自动EMR屏幕上呈阳性。两个屏幕的曲线下面积（AUC）没有显着差异（ITSSAUC=0.745与自动EMR屏幕AUC=0.694，p=0.21），在相同的一般创伤人群中，PTSD风险预测表现相似。ITSS和自动EMR屏幕具有相似的灵敏度(86.5%，89.2%)，和特异性(52.5%，40.9%）分别在其建议的临界点。
结论：两种屏幕在心理测量上具有可比性。因此,创伤中心考虑使用符合ACS-CoT2023任务的PTSD风险筛查工具,应考虑其当地资源和患者人群.无论屏幕选择如何，筛查必须伴随转诊流程,以解决已识别的风险.
