title: Predictors of acute posttraumatic stress disorder symptoms following civilian trauma: highest incidence and severity of symptoms after assault.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) is associated with significant morbidity following injury. The incidence and risk factors for PTSD are not well described in the civilian trauma population. We proposed to screen all trauma patients in the outpatient trauma clinic for acute PTSD symptoms and identify risk factors for PTSD.
  
  
  METHODS
  We prospectively screened 1,386 injured patients who presented for follow-up in trauma clinic (January 2009 to September 2010) using an established PTSD screening test (PTSD Checklist-Civilian, PCL-C). A PCL-C score of ≥35, with a known sensitivity of >85% for PTSD, was considered screen-positive (PCL-C-POS). Backward stepwise logistic regression was used to determine independent risk factors for PCL-C-POS.
  
  
  RESULTS
  Over 25% of trauma clinic patients met the threshold for positive PTSD screen (PCL-C-POS). The highest incidence (43%) was in patients who sustained assault (blunt or penetrating). Regression analysis revealed that age <55 years, female gender, motor vehicle collision, and assaultive mechanism (blunt or penetrating, excluding self-inflicted or accidental injury) were independent predictors of PCL-C-POS status. As the severity of symptoms increased (higher PCL-C scores), the risk associated with assaultive mechanism significantly increased in a dose-response fashion (p < 0.05).
  
  
  CONCLUSIONS
  This study confirms the high incidence of acute PTSD symptoms in trauma patients and supports the feasibility of PTSD screening in the outpatient trauma clinic. Among all mechanisms of injury, patients who sustain interpersonal violence are at the highest risk of developing acute PTSD symptoms. These results suggest that PTSD screening in outpatient trauma clinic may allow early detection and referral of patients with PTSD.
  
  
  METHODS
  II.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. alarconl@upmc.edu
authors.forename: Louis H
authors.initials: LH
authors.lastname: Alarcon
authors.forename: Anne
authors.initials: A
authors.lastname: Germain
authors.forename: Amy S
authors.initials: AS
authors.lastname: Clontz
authors.forename: Eileen
authors.initials: E
authors.lastname: Roach
authors.forename: Dederia H
authors.initials: DH
authors.lastname: Nicholas
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Zenati
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sperry
mesh_terms: D000059:Accidents; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000523:psychology