早期預測因子篩檢工具可預測孩童的PTSD


  Aug. 5, 2003--根據一項最新研究指出,早期預測因子篩檢工具(STEPP)可預測孩童創傷後壓力障礙(PTSD),研究報告刊載於August 6的The Journal of the American Medical Association一份暴力和人權主題期刊。
  
  費城兒童醫院的Flaura K. Winston, MD, PhD在新聞稿中表示,到目前為止,健康照顧提供者沒有一個簡單的方法早一些說出來孩子受傷後誰處於PTSD危險之中,我們希望急性疾病醫師可以使用這個篩檢工具來幫助決定誰應該接受心理評估和干預治療,讓家人避免PTSD。
  
  Dr. Winston說,雖然PTSD在創傷後孩童常見,但診斷不足,STEPP是獨立的篩檢工具在開始治療的時候使用,根據結合事件相關因素,早期生理反應例如心率、早期心理反應等都是日後PTSD進展的較好預測因素,工具包括四個yes/no問題請父母回答,四個yes/no問題請小孩回答,四項資料來自醫療紀錄。
  
  STEPP方面,研究人員有171對夫婦的小孩曾經受傷並於傷後一個月內完成50個問題危險因素的調查的資料,使用的問題來自最常預測持續性PTSD三個月時的反應,這些包括詢問孩子是否與父母分開或孩子非常害怕,詢問父母無助的感覺及是否親眼看到孩子受傷。
  
  STEPP篩檢陽性的孩子,25%有PTSD,27%有PTSD的症狀,STEPP陰性的孩子,5%有PTSD,1%有PTSD症狀;STEPP預測PTSD的敏感性在孩子身上是0.88,父母是0.96,陰性預測值分別是0.95和0.99,PTSD預測的勝算比在孩子身上是6.5 (95%信賴區間[CI], 1.8 - 22.8),父母是26.6(95% CI, 3.5 - 202.1)。
  
  費城兒童醫院的Nancy Kassam-Adams, PhD表示,然而大多數家長和孩子受傷後做得很好,STEPP可幫助發現需要心理支持的人,在精神健康資源缺乏的環境,STEPP可作為一個心理諮詢和干預的分類工具。
  
  The Maternal and Child Health Bureau資助了該研究

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

    
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