A verbal prescreen for intrusive symptoms improves posttraumatic stress disorder screening efficiency

The American College of Surgeons Committee on Trauma requires that trauma centers have a structured approach to identifying patients at risk for mental health conditions. However, the college does not recommend any specific screening protocol. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) is a validated, 20-question screening instrument used at many trauma centers. This study evaluates the diagnostic performance of a verbal, two-question prescreen based on the PCL-5.

All traumatically injured patients were screened for posttraumatic stress disorder (PTSD) via a verbal prescreen based on the first two questions of the PCL-5, followed by the PCL-5 itself. Clinicians were encouraged to adapt the language of the prescreen as they felt appropriate but to evaluate for intrusive memories and nightmares. If the patient endorsed any intrusive symptoms, the prescreen was considered positive. The performance of the verbal prescreen was evaluated using the PCL-5 as the standard at multiple score thresholds.

Of the patients analyzed, 268 completed PTSD screening with the prescreen and PCL-5. Of these, 36.6% (98 of 268 patients) screened positive on the prescreen. The sensitivity was 100% (95% confidence interval, 88-100%), and the specificity was 69% (95% confidence interval, 62-76%) for our institutional positive threshold of 30 points on the PCL-5, with a positive predictive value of 21% and a negative predictive value of 100%.

A simple verbal prescreen for intrusive symptoms of PTSD can reduce the number of required PCL-5 screenings by 63% without sacrificing sensitivity. This prescreen increases efficiency of PTSD screening without the need for specialized psychiatric personnel or additional resources.

Diagnostic Tests or Criteria; Level III.