title: A brief screening tool for assessing psychological trauma in clinical practice: development and validation of the New York PTSD Risk Score.
abstract: OBJECTIVE
  The objective was to develop a brief posttraumatic stress disorder (PTSD) screening instrument that is useful in clinical practice, similar to the Framingham Risk Score used in cardiovascular medicine.
  
  
  METHODS
  We used data collected in New York City after the World Trade Center disaster (WTCD) and other trauma data to develop a new PTSD prediction tool--the New York PTSD Risk Score. We used diagnostic test methods to examine different clinical domains, including PTSD symptoms, trauma exposures, sleep disturbances, suicidal thoughts, depression symptoms, demographic factors and other measures to assess different PTSD prediction models.
  
  
  RESULTS
  Using receiver operating curve (ROC) and bootstrap methods, five prediction domains, including core PTSD symptoms, sleep disturbance, access to care status, depression symptoms and trauma history, and five demographic variables, including gender, age, education, race and ethnicity, were identified. For the best prediction model, the area under the ROC curve (AUC) was 0.880 for the Primary Care PTSD Screen alone (specificity=82.2%, sensitivity=93.7%). Adding care status, sleep disturbance, depression and trauma exposure increased the AUC to 0.943 (specificity=85.7%, sensitivity=93.1%), a significant ROC improvement (P<.0001). Adding demographic variables increased the AUC to 0.945, which was not significant (P=.250). To externally validate these models, we applied the WTCD results to 705 pain patients treated at a multispecialty group practice and to 225 trauma patients treated at a Level I Trauma Center. These results validated those from the original WTCD development and validation samples.
  
  
  CONCLUSIONS
  The New York PTSD Risk Score is a multifactor prediction tool that includes the Primary Care PTSD Screen, depression symptoms, access to care, sleep disturbance, trauma history and demographic variables and appears to be effective in predicting PTSD among patients seen in healthcare settings. This prediction tool is simple to administer and appears to outperform other screening measures.
authors.affiliation: Center for Health Research, Geisinger Clinic, Danville, PA 17822-4400, USA. jaboscarino@geisinger.edu
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Boscarino
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.forename: Stuart N
authors.initials: SN
authors.lastname: Hoffman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sartorius
authors.forename: Richard E
authors.initials: RE
authors.lastname: Adams
authors.forename: Charles R
authors.initials: CR
authors.lastname: Figley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003866:Depressive Disorder; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010146:Pain / Q000523:psychology; D010414:Pennsylvania; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D047851:September 11 Terrorist Attacks; D012893:Sleep Wake Disorders / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D014193:Trauma Centers; D055815:Young Adult