Screening tools for Predicting PSTD in Acutely Injured Adult Trauma Patients: a Systematic Review

Introduction: Adult trauma patients are at risk of developing post-traumatic stress disorder (PTSD). Early intervention reduces the development of PTSD in traumatized patients, but few patients seek and obtain care. Valid and reliable PTSD screening tools are needed to identify patients at risk of developing PTSD and who would most benefit from early intervention. Methods: PubMed, PsychInfo, and ClinicalTrials.gov were searched from database inception through April 2020. Studies evaluating the predictive accuracy of PTSD screening tools among traumatically injured adult civilians when performed during acute hospitalization were included. Eligible studies had to compare screening test results with assessment of PTSD diagnosis (or likely diagnosis) at least one month later. Eligible outcomes included measures of predictive accuracy, such as sensitivity and specificity. The QUADAS-2 tool was used to assess the risk of bias of each study, and the strength of evidence was assessed following Agency for Healthcare Research and Quality guidelines. Results: Twenty-nine studies were included evaluating the predictive accuracy of twenty-three screening tools. Most tools were assessed in a single study. Questionnaire-style tools had more favorable predictive ability than diagnostic interview assessments. The Injured Trauma Survivor Screen (ITSS), Posttraumatic Adjustment Screen (PAS), the PTSD checklist for DSM V (PCL-5), and the Richmond et al. tool demonstrated the most favorable predictive accuracy, with high sensitivity (75-100%), specificity (67-94%), and negative predictive value (89-100%). Common sources of bias were selection bias due to inappropriate exclusion criteria, using non-diagnostic tools to assess PTSD symptoms at follow-up, and high attrition rate. Discussion: Although sensitivity and specificity of the predictive tools varied widely, several emerged with favorable predictive accuracy. Further research is needed to define the ability of screening and intervention to prevent PTSD in injured trauma survivors. The results of this review can inform screening tool options for future intervention studies.Master of Public Healt