Validation of Patient-Reported Outcome Measurement Information System (PROMIS) for Detection of Posttraumatic Stress in Children and Adolescents Following Procedures for Acute Orthopaedic Trauma
Collin May, Hillary Brenda Nguyen, Patricia Miller, Justyna Klajn, Emily S. Rademacher, Michaela O’Connor, Daniel Hedequist, Benjamin Shore
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引用次数: 0
Abstract
The efficiency and validity of PROMIS surveys were determined for pediatric orthopaedic trauma patients with posttraumatic stress disorder (PTSD) symptoms in a clinic setting.
Design: Prospective cohort study.
Single-institution, Level I Trauma Center.
All consecutive children aged 8-18 years undergoing procedures or surgery for orthopaedic trauma.
Outcome Measures and Comparisons: The convergent, divergent, and discriminant validity of the PROMIS Anger and Anxiety computerized adaptive tests (CATs) were evaluated and compared to the previously validated Child PTSD Symptom Scale (CPSS). The efficiency in time to completion of the outcome measures was compared between the CPSS and PROMIS surveys. Cutoffs for increased likelihood of PTSD were established for the PROMIS questionnaires.
A total of 233 subjects were included in this study (mean age 13.1 years with SD 2.8 years, 71% male). The majority (51%) of injuries were sports-related and most (60%) involved the upper extremity. Of those included, 41 patients had high levels of PTSD symptoms on the CPSS (18%; 95% CI=13.1-23.2%). The CPSS took 182 (IQR 141-228) seconds versus 52 (IQR 36-84) and 52 (IQR 36-70) seconds for PROMIS Anger and Anxiety CATs, respectively. Convergent validity showed patient scores on both PROMIS instruments significantly correlated with CPSS scores (Anger: p<0.001, r=0.51; Anxiety: p<0.001, r=0.41). Neither PROMIS score correlated with UCLA Activity Score (Anger: r=-0.26; Anxiety: r=-0.22), a functional outcome measure, demonstrating divergent validity. Both PROMIS instruments sufficiently discriminated across PTSD risk groups (Anger p<0.001; Anxiety p<0.001). A score of at least 53 on PROMIS Anger or at least 48 on PROMIS Anxiety indicated an increased likelihood of PTSD risk.
PROMIS Anger and Anxiety CATs are efficient and valid for evaluating posttraumatic stress in children following orthopaedic trauma procedures.
Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
期刊介绍:
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.