Post-traumatic stress disorder screening test performance in civilian primary care
Post-traumatic stress disorder screening test performance in civilian primary care
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DOI：
10.1093/fampra/cmq049
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发表时间：
2010-12-01
期刊：
影响因子：
2.2
通讯作者：
Carek, Peter J.
中科院分区：
文献类型：
--
作者：
Freedy, John R.;Steenkamp, Maria M.;Carek, Peter J.
方法。这是一项针对参加美国东南部家庭医学住院医师培训诊所的成年人的横断面队列研究。四百一十一名参与者在指数诊所访问后完成了结构化电话访谈。筛查测试包括：PTSD症状检查表-民用版（17项）、SPAN（4项）、Breslau量表（7项）和初级保健PTSD筛查（PC-PTSD）（4项）。使用修改后的临床医生管理的 PTSD 量表来确定过去一个月的 PTSD 以进行比较。基于曲线下面积 (AUC) 的受试者操作特征分析用于评估诊断效率（期望> 0.80）。选择截止分数以产生最佳的敏感性和特异性 (> 80%)。 结果。过去一个月的 PTSD 显着（女性 = 35.8%，男性 = 20.0%；P < 0.01）。 AUC 值为 PTSD 症状检查表 (PCL) (0.897)、SPAN (0.806)、Breslau 量表 (0.886) 和 PC-PTSD (0.885)。最佳截止分数产生以下敏感性和特异性：PCL（80.0％和80.7％；截止值= 43），SPAN（75.9％和71.6％；截止值= 3），布雷斯劳量表（84.5％和76.4％；截止值= 4）和PC-PTSD（85.1％和82.0％；截止值= 3）。截止=3）。探讨了总体和特定性别的筛选测试表现。结论。结果证实： (i) 创伤后应激障碍 (PTSD) 很常见，尤其是在女性中； (ii) 所有四项 PTSD 筛查测试在诊断上都是充分的； (iii) 四项 PTSD 筛查测试中的两项显示出足够的敏感性和特异性 (> 80%) 和 (iv) PC-PTSD 筛查测试（四项）似乎是最好的单一筛查测试。很少有研究证实 PTSD 筛查测试在民用初级保健中的实用性。
Methods. This was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit. Screening tests included: PTSD Symptom Checklist-Civilian Version (17 items), SPAN (four items), Breslau's scale (seven items) and Primary Care PTSD screen (PC-PTSD) (four items). A modified Clinician-Administered PTSD Scale was used to determine past month PTSD for comparison. Receiver operating characteristic analysis based on area under the curve (AUC) was used to assess diagnostic efficiency (> 0.80 desired). Cut-off scores were selected to yield optimal sensitivity and specificity (> 80%).Results. Past month PTSD was substantial (women = 35.8% and men = 20.0%; P < 0.01). AUC values were PTSD Symptom Checklist (PCL) (0.897), SPAN (0.806), Breslau's scale (0.886) and PC-PTSD (0.885). Optimal cut-scores yielded the following sensitivities and specificities: PCL (80.0% and 80.7%; cut-off = 43), SPAN (75.9% and 71.6%; cut-off = 3), Breslau's scale (84.5% and 76.4%; cut-off = 4) and PC-PTSD (85.1% and 82.0%; cut-off = 3). Overall and gender-specific screening test performances were explored.Conclusions. Results confirm: (i) PTSD was common, especially among women; (ii) all four PTSD screening tests were diagnostically adequate; (iii) Two of four PTSD screening tests showed adequate sensitivity and specificity (> 80%) and (iv) The PC-PTSD screening test (four items) appeared to be the best single screening test. There are few studies to establish the utility of PTSD screening tests within civilian primary care.