Els van Meijel

128 Chapter 8 | Summary and 18 years of age but an exploratory study directed at children below the age of 8 is also included. Screening for risk of PTSD after accidental injury Chapter 2 described the results of the evaluation of the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP) in a mixed-trauma sample in the Netherlands. Children aged 8-18 and one of their parents were recruited at two academic level I trauma centers: AMC and VUmc in Amsterdam, the Netherlands. The STEPP is a stand-alone screening tool. It was developed for use in the acute care setting and for assessment by trained professionals. It consists of 12 questions: 4 questions are asked of the child, 4 questions are asked of the parent and 4 items are obtained from the medical records. Including the items from the medical records, the total score for children is based on 8 items, and the total score for parents is based on 6 items. The items are answered dichotomously with “yes” (= 1) or “no” (= 0). The STEPP was assessed in 161 children (mean age 13.9 years) and 156 parents within one week of the accident. Three months later, clinical diagnoses and symptoms of PTSD were assessed in 147 children and 135 parents. Receiver Operating Characteristic analyses were performed to estimate the performance and to determine the optimal cut-off score in the sample. Since the purpose of screening is to identify children and parents who are at risk of PTSD, a high sensitivity is required, while those who are unlikely to develop PTSD should be screened out with a high negative predictive value. PTSDwas diagnosed in 11.6% of the children; 9.6% of their parents scored above the cut-off point for PTSD. At the originally recommended cut-off scores (4 for children, 3 for parents), the sensitivity in our sample was 41% for children and 54% for parents. Negative predictive values were 92% for both groups. Adjusting the cut-off scores to 2 improved sensitivity to 82% for children and 92% for parents, with negative predictive values of 92% and 96%, respectively. With adjusted cut-off scores, the STEPP performed well: 82% of the children and 92% of the parents with a subsequent positive diagnosis were identified correctly. The study results show that the STEPP is a valid and useful instrument that can be used in the Netherlands as a first screening method in stepped psychotrauma care following accidents. Due to a high rate of false positives, however, special attention in the screening procedure is required.