title: Predicting posttraumatic stress disorder in children and parents following accidental child injury: evaluation of the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP).
abstract: BACKGROUND
  Children and their parents are at risk of posttraumatic stress disorder (PTSD) following injury due to pediatric accidental trauma. Screening could help predict those at greatest risk and provide an opportunity for monitoring so that early intervention may be provided. The purpose of this study was to evaluate the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP) in a mixed-trauma sample in a non-English speaking country (the Netherlands).
  
  
  METHODS
  Children aged 8-18 and one of their parents were recruited in two academic level I trauma centers. The STEPP was assessed in 161 children (mean age 13.9 years) and 156 parents within one week of the accident. Three months later, clinical diagnoses and symptoms of PTSD were assessed in 147 children and 135 parents. We used the Anxiety Disorders Interview Schedule for DSM-IV - Child and Parent version, the Children's Revised Impact of Event Scale and the Impact of Event Scale-Revised. Receiver Operating Characteristic analyses were performed to estimate the Areas Under the Curve as a measure of performance and to determine the optimal cut-off score in our sample. Sensitivity, specificity, positive and negative predictive values were calculated. The aim was to maximize both sensitivity and negative predictive values.
  
  
  RESULTS
  PTSD was diagnosed in 12% of the children; 10% of their parents scored above the cut-off point for PTSD. At the originally recommended cut-off scores (4 for children, 3 for parents), the sensitivity in our sample was 41% for children and 54% for parents. Negative predictive values were 92% for both groups. Adjusting the cut-off scores to 2 improved sensitivity to 82% for children and 92% for parents, with negative predictive values of 92% and 96%, respectively.
  
  
  CONCLUSIONS
  With adjusted cut-off scores, the STEPP performed well: 82% of the children and 92% of the parents with a subsequent positive diagnosis were identified correctly. Special attention in the screening procedure is required because of a high rate of false positives. The STEPP appears to be a valid and useful instrument that can be used in the Netherlands as a first screening method in stepped psychotrauma care following accidents.
authors.affiliation: Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. e.vanmeijel@debascule.com.|de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands. e.vanmeijel@debascule.com.
authors.forename: Els P M
authors.initials: EP
authors.lastname: van Meijel
authors.affiliation: Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. m.gigengack@debascule.com.|de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands. m.gigengack@debascule.com.
authors.forename: Maj R
authors.initials: MR
authors.lastname: Gigengack
authors.affiliation: Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. e.verlinden@debascule.com.|de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands. e.verlinden@debascule.com.
authors.forename: Eva
authors.initials: E
authors.lastname: Verlinden
authors.affiliation: Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. b.c.opmeer@amc.uva.nl.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
authors.affiliation: Pediatric Surgical Center of Amsterdam, Academic Medical Center, University of Amsterdam and VU University medical center, Amsterdam, the Netherlands. hugo.heij@icloud.com.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Heij
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. j.c.goslings@amc.uva.nl.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Department of Surgery, VU University medical center, Amsterdam, the Netherlands. fw.bloemers@vumc.nl.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Bloemers
authors.affiliation: Emergency Department, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. j.s.luitse@amc.uva.nl.
authors.forename: Jan S K
authors.initials: JS
authors.lastname: Luitse
authors.affiliation: Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. f.boer@amc.uva.nl.
authors.forename: Frits
authors.initials: F
authors.lastname: Boer
authors.affiliation: Pediatric Psychology Department of the Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. m.a.grootenhuis@amc.uva.nl.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Grootenhuis
authors.affiliation: Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. r.lindauer@debascule.nl.|de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands. r.lindauer@debascule.nl.
authors.forename: Ramón J L
authors.initials: RJ
authors.lastname: Lindauer
mesh_terms: D000059:Accidents / Q000523:psychology*; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009426:Netherlands; D010290:Parents / Q000523:psychology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011580:Psychological Techniques; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000209:etiology / Q000523:psychology