title: Posttraumatic stress disorder in survivors of acute lung injury: evaluating the Impact of Event Scale-Revised.
abstract: BACKGROUND
  Survivors of acute lung injury (ALI) and other critical illnesses often experience substantial posttraumatic stress disorder (PTSD) symptoms. However, most questionnaires have not been validated against a PTSD diagnostic reference standard in this patient population. Hence, in the current study of survivors of ALI, we evaluated the Impact of Events Scale-Revised (IES-R), a questionnaire measure of PTSD symptoms, against the Clinician-Administered PTSD Scale (CAPS), the current state-of-the-art PTSD diagnostic reference standard, which also provides a quantitative assessment of PTSD symptoms.
  
  
  METHODS
  We evaluated the IES-R questionnaire vs the CAPS diagnostic interview in 60 of 77 consecutively recruited survivors of ALI from two prospective cohort studies of patients 1 to 5 years after ALI.
  
  
  RESULTS
  The IES-R total score (range: 0.0-3.2) and the CAPS total severity score (range: 0-70) were strongly related (Pearson r=0.80, Spearman ρ=0.69). Using CAPS data, eight of the 60 patients (13%) had PTSD at the time of assessment, and an additional eight patients had partial PTSD (total prevalence, 27%). In a receiver operating characteristics curve analysis with CAPS PTSD or partial PTSD as criterion variables, the area under the curve ranged from 95% (95% CI, 88%-100%) to 97% (95% CI, 92%-100%). At an IES-R threshold of 1.6, with the same criterion variables, sensitivities ranged from 80% to 100%, specificities 85% to 91%, positive predictive values 50% to 75%, negative predictive values 93% to 100%, positive likelihood ratios 6.5 to 9.0, negative likelihood ratios 0.0 to 0.2, and efficiencies 87% to 90%.
  
  
  CONCLUSIONS
  The IES-R appears to be an excellent brief PTSD symptom measure and screening tool in ALI survivors.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Group, Baltimore, MD; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. Electronic address: jbienven@jhmi.edu.
authors.forename: O Joseph
authors.initials: OJ
authors.lastname: Bienvenu
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Baltimore, MD.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Williams
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Andrew
authors.initials: A
authors.lastname: Yang
authors.affiliation: Medicine, Pulmonary, and Critical Care, Intermountain Medical Center, and Psychology and Neuroscience Center, Brigham Young University, Salt Lake City, UT.
authors.forename: Ramona O
authors.initials: RO
authors.lastname: Hopkins
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Baltimore, MD.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D055371:Acute Lung Injury / Q000523:psychology*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D062489:Health Impact Assessment / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States