Routine versus ad hoc screening for acute stress following injury: who would benefit and what are the opportunities for prevention.
BACKGROUND
Screening for acute stress is not part of routine trauma care owing in part to high variability of acute stress symptoms in identifying later onset of posttraumatic stress disorder (PTSD). The objective of this pilot study was to assess the sensitivity, specificity, and power to predict onset of PTSD symptoms at 1 and 4 months using a routine screening program in comparison to current ad hoc referral practice.


METHODS
Prospective cross-sectional observational study of a sample of hospitalized trauma patients over a four-month period from a level-I hospital in Canada. Baseline assessments of acute stress (ASD) and subsyndromal ASD (SASD) were measured using the Stanford Acute Stress Reaction Questionnaire (SASRQ). In-hospital psychiatric consultations were identified from patient discharge summaries. PTSD symptoms were measured using the PTSD Checklist-Specific (PCL-S). Post-discharge health status and health services utilization surveys were also collected.


RESULTS
Routine screening using the ASD (0.43) and SASD (0.64) diagnoses were more sensitive to PTSD symptoms at one month in comparison to ad hoc referral (0.14) and also at four months (0.17, 0.33 versus 0.17). Ad hoc referral had greater positive predictive power in identifying PTSD caseness at 1 month (0.50) in comparison to the ASD (0.46) and SASD (0.43) diagnoses and also at 4 months (0.67 versus 0.25 and 0.29).


CONCLUSIONS
Ad hoc psychiatric referral process for acute stress is a more conservative approach than employing routine screening for identifying persons who are at risk of psychological morbidity following injury. Despite known limitations of available measures, routine patient screening would increase identification of trauma survivors at risk of mental health sequelae and better position trauma centers to respond to the circumstances that affect mental health during recovery.
Department of Surgery, University of British Columbia, 855 West 10th Avenue, Vancouver, British Columbia V5Z 1 M9, Canada ; College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC 29208, USA.
Nathaniel
N
Bell
School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada.
Boris
B
Sobolev
Department of Psychiatry, University of British Columbia, 855 West 10th Avenue, Vancouver, British Columbia V5Z 1 M9, Canada.
Stephen
S
Anderson
Department of Psychiatry, University of British Columbia, 855 West 10th Avenue, Vancouver, British Columbia V5Z 1 M9, Canada.
Robert
R
Hewko
Department of Surgery, University of British Columbia, 855 West 10th Avenue, Vancouver, British Columbia V5Z 1 M9, Canada.
Richard K
RK
Simons
Screening; Trauma systems; Traumatic stress/PTSD