STEPP Predicts PTSD in Childre
By Laurie Barclay, MD
Medscape Medical News
Aug. 5, 2003 — The Screening Tool for Early Predictors of PTSD (STEPP) predicts posttraumatic stress disorder (PTSD) in children, according to a report in the August 6 issue of The Journal of the American Medical Association, a violence and human rights theme issue.
"Until now, health care providers did not have a simple way to tell, early on, who could be at risk of PTSD after a child injury," coauthor Flaura K. Winston, MD, PhD, from The Children's Hospital of Philadelphia in Pennsylvania, says in a news release. "We hope that acute care physicians can use this screening tool to help determine who should be referred for psychological evaluation and intervention so that families can avoid PTSD."
Although PTSD is common in children after traumatic injury, Dr. Winston says it is underdiagnosed. The STEPP is a stand-alone screening tool designed for use at the initial treatment visit, based on a combination of event-related factors, early physiological reactions such as heart rate, and early psychological responses, which are better predictors of future development of PTSD than is severity of injury. The tool consists of four yes/no questions asked of the parent, four yes/no questions asked of the child, and four items easily obtained from medical records.
To develop the STEPP, the investigators had 171 couples whose child had traffic-related injuries complete a 50-question risk factor survey within one month of injury. Questions used for the STEPP were derived from the combination of responses that most often predicted persistent PTSD at three months. These included asking the child if they were separated from their parents or had been very afraid, and asking the parent about feelings of helplessness and whether they had witnessed the child's injury.
Of children who screened positive on the STEPP, 25% developed PTSD and 27% developed symptoms of PTSD. Of children with a negative STEPP, 5% developed PTSD and 1% developed PTSD symptoms. Sensitivity of the STEPP in predicting PTSD was 0.88 for children and 0.96 for parents, and negative predictive values were 0.95 and 0.99, respectively. The odds ratio for prediction of PTSD was 6.5 (95% confidence interval [CI], 1.8 - 22.8) in children and 26.6 (95% CI, 3.5 - 202.1) in parents.
"While most parents and children do well following a traumatic injury, STEPP can help find those in need of psychological support," says coauthor Nancy Kassam-Adams, PhD, also from Children's Hospital. "In an environment where mental health resources are scarce, STEPP can serve as a triage tool for psychological referral and intervention."
The Maternal and Child Health Bureau funded this study.
JAMA. 2003;290:643-649
Reviewed by Gary D. Vogin, MD
