Els van Meijel

27 Evaluation of the STEPP | Chapter 2 Measures Injury severity and trauma-related characteristics The Injury Severity Score (ISS; Baker, O’Neill, Haddon, & Long, 1974) was obtained from the trauma registry. The ISS is a method for describing the severity of injuries in trauma patients. It is related to the likelihood of survival after injury. The ISS is determined by rating the severity of each injury in six body areas (head, neck, face, chest, abdomen, extremity and external) on the six-point Abbreviated Injury Scale (AIS). The ISS is derived from the sum of the squares of the AIS score and has a range of 0-75 (Baker et al., 1974; Saxe et al., 2005). Information on length of hospitalization and trauma type was obtained from the medical records. Screening for risk of PTSD The STEPP (see Figure 2.1) is a theoretically derived, empirically validated, stand-alone screening tool (Winston et al., 2003). 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). A score of 4 or higher for children and 3 or higher for parents results in a positive screening (Winston et al., 2003). For children, the STEPP has shown a sensitivity of 0.88, a specificity of 0.48, a positive predictive value of 0.25 and a negative predictive value of 0.95. For parents, the STEPP has shown a sensitivity of 0.96, a specificity of 0.53, a positive predictive value of 0.27 and a negative predictive value of 0.99. Test-retest reliability was excellent for children (κ = 0.86) and very good for parents (κ = 0.67) (Winston et al., 2003). After acquiring permission from the authors, the STEPP was translated into Dutch and then back-translated by a native English speaker. The authors informed us in detail about using, scoring and interpreting the STEPP. Diagnosed children’s posttraumatic stress disorder To diagnose PTSD in children we used the Dutch version of the Anxiety Disorders Interview Schedule for DSM-IV - Child and Parent Version (ADIS-C/P; Siebelink & Treffers, 2001; Silverman & Albano, 1996) with an extended adaptation of the PTSD module, including detailed information on trauma history (Verlinden, van Meijel,