title: The casualty chain inventory: a new scale for measuring peritraumatic responses: a cross-sectional study.
abstract: BACKGROUND
  Peritraumatic psychological- and sensory impressions in victims of civilian accidents are only partly understood. This study scrutinizes the level and duration of perceived psychological threat at scene of injury as well as in hospital (the casualty chain) measured by the Casualty Chain Inventory (CCI). The purpose of the study was to assess and validate the CCI, and to examine the correlations between the new instrument and stress responses measured by the Impact of Event Scale (IES) and the Post-traumatic Stress Scale-10 (PTSS-10)
  
  
  METHODS
  Three hundred and fifteen injured, conscious, hospitalised patients were assessed with a self-report questionnaire. The CCI consists of eight items including sensory impressions and well-known psychological responses to trauma.
  
  
  RESULTS
  The internal consistency of the CCI was solid (Cronbach's alpha: .83-.85). A factor analysis revealed two components, "perception" and "dissociation". The instrument correlates significantly with the Impact of Event Scale (r = 0.47 - 0.54) and the Posttraumatic Stress Scale-10 (r = 0.32 - 0.50). The explained variance is high both at the scene of injury (61%) and in the hospital (65%). Dissociation and perception either used as a two-factor solution or as a sum score measured in the hospital, gave the strongest prediction for later psychological distress.
  
  
  CONCLUSIONS
  The CCI appears to be a useful screening instrument for, at an early state, identifying patients hospitalized after a physical incident at risk for subsequent psychological distress.
authors: Department of Research and Development, Division of Critical Care, Oslo University Hospital, Ulleval, Norway. Laila.Skogstad@oslo-universitetssykehus.no
authors: Laila
authors: L
authors: Skogstad
authors: Erlend
authors: E
authors: Hem
authors: Leiv
authors: L
authors: Sandvik
authors: Øivind
authors: Ø
authors: Ekeberg
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