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. 2013 Jul;144(1):24-31.
doi: 10.1378/chest.12-0908.

Posttraumatic Stress Disorder in Survivors of Acute Lung Injury: Evaluating the Impact of Event Scale-Revised

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Free PMC article

Posttraumatic Stress Disorder in Survivors of Acute Lung Injury: Evaluating the Impact of Event Scale-Revised

O Joseph Bienvenu et al. Chest. .
Free PMC article

Abstract

Background: Survivors of acute lung injury (ALI) and other critical illnesses often experience substantial posttraumatic stress disorder (PTSD) symptoms. However, most questionnaires have not been validated against a PTSD diagnostic reference standard in this patient population. Hence, in the current study of survivors of ALI, we evaluated the Impact of Events Scale-Revised (IES-R), a questionnaire measure of PTSD symptoms, against the Clinician-Administered PTSD Scale (CAPS), the current state-of-the-art PTSD diagnostic reference standard, which also provides a quantitative assessment of PTSD symptoms.

Methods: We evaluated the IES-R questionnaire vs the CAPS diagnostic interview in 60 of 77 consecutively recruited survivors of ALI from two prospective cohort studies of patients 1 to 5 years after ALI.

Results: The IES-R total score (range: 0.0-3.2) and the CAPS total severity score (range: 0-70) were strongly related (Pearson r=0.80, Spearman ρ=0.69). Using CAPS data, eight of the 60 patients (13%) had PTSD at the time of assessment, and an additional eight patients had partial PTSD (total prevalence, 27%). In a receiver operating characteristics curve analysis with CAPS PTSD or partial PTSD as criterion variables, the area under the curve ranged from 95% (95% CI, 88%-100%) to 97% (95% CI, 92%-100%). At an IES-R threshold of 1.6, with the same criterion variables, sensitivities ranged from 80% to 100%, specificities 85% to 91%, positive predictive values 50% to 75%, negative predictive values 93% to 100%, positive likelihood ratios 6.5 to 9.0, negative likelihood ratios 0.0 to 0.2, and efficiencies 87% to 90%.

Conclusions: The IES-R appears to be an excellent brief PTSD symptom measure and screening tool in ALI survivors.

Figures

Figure 1.
Figure 1.
Convergence of two measures of PTSD symptoms in the last week before interview: the IES-R total score vs the CAPS total severity score. Lines indicate the slope and 95% CI of a fitted linear regression line; Pearson r = 0.80 (P < .0005) and Spearman ρ = 0.69 (P < .0005). CAPS = Clinician-Administered PTSD Scale; IES-R = Impact of Events Scale-Revised; PTSD = postraumatic stress disorder.
Figure 2.
Figure 2.
Receiver operating characteristics (ROC) curve for the IES-R total score (test variable) vs CAPS (criterion variable, eight of 60 patients). The area under the ROC curve is 95% (95% CI, 88%-100%). See Figure 1 legend for expansion of abbreviations.
Figure 3.
Figure 3.
Flow diagram of the diagnostic accuracy of an IES-R total score threshold ≥ 1.6 using CAPS PTSD as the criterion variable. See Figure 1 legend for expansion of abbreviations.

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