Validation of the Injured Trauma Survivor Screen: An American Association for the Surgery of Trauma multi-institutional trial.

BACKGROUND: Psychological distress is common following a traumatic injury event. The Injured Trauma Survivor Screen (ITSS) was developed at a level 1 trauma center to assess for posttraumatic stress disorder (PTSD) and major depressive episode (MDE) following admission for a traumatic injury. The ITSS sensitivity and specificity were analyzed 1 to 3 and 6 to 9 months postinjury to test the validity across trauma centers. METHOD: Four level 1 trauma centers from the East, Midwest, South, and West in the United States recruited 375 eligible adult inpatients (excluded participants included those with moderate or severe traumatic brain injury, whose injury was self-inflicted, were noncommunicative, or were non-English speaking). Baseline sample (White/Caucasian, 63.2%; male, 62.4%; mean (SD) age, 45 (17.11) years; injured by motor vehicle collision, 42.4%) measurements were conducted during index hospitalization. At first follow-up, 69.6% (n = 261) were retained; at second follow-up, 61.3% (n = 230) were retained. Measurements included the ITSS, PTSD Checklist for DSM-5, Center for Epidemiologic Studies Depression Scale-Revised, and Clinician-Administered PTSD Scaled for DSM 5. RESULTS: At follow-up 1, the ITSS PTSD subscale had a sensitivity of 75% and specificity of 78.8%, and the MDE subscale had a sensitivity of 80.4% and specificity of 65.6%. At follow-up 2, the PTSD subscale had a sensitivity of 72.7% and specificity of 83.1%, and the MDE subscale had a sensitivity of 76.1% and specificity of 68.3%. A combined risk group using two symptom based measures administered at baseline produced increased specificity. CONCLUSION: The nine-item ITSS continues to be an efficient and effective risk screen for PTSD and MDE following traumatic injury requiring hospitalization. This multi-institutional validation study creates a solid foundation for further exploration of the generalizability of this screen's psychometric properties in distinct populations. LEVEL OF EVIDENCE: Prognostic study, level III.

Critical call for hospital-based domestic violence intervention: The Davis Challenge.

BACKGROUND: Fifty percent of women killed in intimate partner violence (IPV) were seen by a health care provider within a year of their death. As guest speaker to Virginia Commonwealth University Trauma Center (VCU-TC), Dr. James Davis (Western Trauma Association past president) challenged VCU-TC to develop a hospital-based IPV program. This research examines the development and impact of an integrated hospital/VCU-TC-based IPV program. METHODS: The IPV survey was carried out to determine need for training and screening. Hospital forensic nurse examiners case logs were evaluated to determine IPV prevalence. An integrated IPV program-Project Empower was developed, consisting of staff education, patient screening, victim crisis fund, and interdisciplinary sexual assault/domestic violence intervention team. Between 2014 and 2018, patients admitted with an IPV consult to Project Empower were entered into a secure database capturing demographics, mechanisms, income data, and social determinants of risk. Program feasibility was evaluated on patient engagement via screening and case management. Program impact was evaluated on crisis intervention, safety planning, and community referral. RESULTS: Forensic nurse examiner data and IPV survey evaluation noted 20% IPV prevalence and lack of IPV screening and training. The IPV patients (N = 799) were women (90%), unmarried (79%) and African-American (60%). Primary mechanisms were firearm (44%) or stabbing (34%). Survivors were perpetrated by a cohabiting (42%) or dating partner (18%). Monthly income averaged US $622. Forty percent had no health insurance. Advocates provided 62% case management. Survivors received victim crisis funds (16%), safety planning (68%), crisis intervention (78%), sexual and domestic violence education (83%), and community referral (83%). Within 5 years, 35 (4%) were reinjured and seen in the emergency department. Thirty-one (4%) were readmitted for IPV-related injuries. Two deaths were attributed to IPV. CONCLUSION: Critical call for hospital-based IPV intervention programs as a priority for trauma centers to adopt cannot be underestimated but can be answered in a comprehensive integrated model. LEVEL OF EVIDENCE: Therapeutic, level I.