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The Aberdeen Trauma Screening Index: an instrument to predict post-accident psychopathology

Published online by Cambridge University Press:  15 August 2002

S. KLEIN
Affiliation:
From the Department of Mental Health and Aberdeen Centre for Trauma Research, Department of Orthopaedic Surgery and Department of General Practice and Primary Care, University of Aberdeen, and Department of Clinical Psychology, Royal Cornhill Hospital, Grampian Primary Care NHS Trust, Aberdeen
D. A. ALEXANDER
Affiliation:
From the Department of Mental Health and Aberdeen Centre for Trauma Research, Department of Orthopaedic Surgery and Department of General Practice and Primary Care, University of Aberdeen, and Department of Clinical Psychology, Royal Cornhill Hospital, Grampian Primary Care NHS Trust, Aberdeen
J. D. HUTCHINSON
Affiliation:
From the Department of Mental Health and Aberdeen Centre for Trauma Research, Department of Orthopaedic Surgery and Department of General Practice and Primary Care, University of Aberdeen, and Department of Clinical Psychology, Royal Cornhill Hospital, Grampian Primary Care NHS Trust, Aberdeen
J. A. SIMPSON
Affiliation:
From the Department of Mental Health and Aberdeen Centre for Trauma Research, Department of Orthopaedic Surgery and Department of General Practice and Primary Care, University of Aberdeen, and Department of Clinical Psychology, Royal Cornhill Hospital, Grampian Primary Care NHS Trust, Aberdeen
J. M. SIMPSON
Affiliation:
From the Department of Mental Health and Aberdeen Centre for Trauma Research, Department of Orthopaedic Surgery and Department of General Practice and Primary Care, University of Aberdeen, and Department of Clinical Psychology, Royal Cornhill Hospital, Grampian Primary Care NHS Trust, Aberdeen
J. S. BELL
Affiliation:
From the Department of Mental Health and Aberdeen Centre for Trauma Research, Department of Orthopaedic Surgery and Department of General Practice and Primary Care, University of Aberdeen, and Department of Clinical Psychology, Royal Cornhill Hospital, Grampian Primary Care NHS Trust, Aberdeen

Abstract

Background. A key challenge in trauma care is the prevention of psychopathology. However, no definitive method of identifying individuals at risk of developing psychopathology exists. The Aberdeen Trauma Screening Index (ATSI) is a brief screening tool developed for use in a clinical setting by non-mental health professionals to facilitate the early identification of individuals most at risk of psychopathology 3-months post-accident.

Methods. The ATSI derived from a prospective study of a 150 out of an initial pool of 213 consecutive admissions to the Orthopaedic Trauma Unit and the Accident and Emergency Department of Aberdeen Royal Infirmary. Potential predictors were identified by a comprehensive assessment conducted within 1-week post-accident. Outcome at 3-months post-accident was measured using ‘caseness’ according to the General Health Questionnaire (GHQ-28).

Results. The ATSI is based on a final model comprising only seven variables with a sensitivity of 79% and specificity of 65%. A predictive index score (0–100) was produced to ensure the practical utility of the ATSI in a clinical setting. A ROC curve was constructed to illustrate the relationship between sensitivity and the specificity values with their corresponding threshold scores. On the basis of a prevalence rate of 55% ‘caseness’, as identified in the present study, a cut-off point of 45 provides the optimal outcome with a sensitivity value of 70% and a specificity value of 71%.

Conclusions. The ATSI can accurately identify those most at risk of developing psychopathology 3-months post-accident in a sample of accidentally injured adult subjects recruited as consecutive admissions to an urban hospital in the North East of Scotland. However, to establish the generalizability of these findings, it is important that the ATSI be validated in both similar and diverse populations.

Type
Research Article
Copyright
© 2002 Cambridge University Press

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