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Original Research: Critical Care |

Posttraumatic Stress Disorder in Survivors of Acute Lung InjuryPosttraumatic Stress Disorder in Acute Lung Injury: Evaluating the Impact of Event Scale-Revised

O. Joseph Bienvenu, MD, PhD; Jason B. Williams, MD; Andrew Yang, BS; Ramona O. Hopkins, PhD; Dale M. Needham, MD, PhD
Author and Funding Information

From the Department of Psychiatry and Behavioral Sciences (Drs Bienvenu and Williams), Outcomes After Critical Illness and Surgery (OACIS) Group (Drs Bienvenu and Needham), Division of Pulmonary and Critical Care Medicine (Dr Needham), and Department of Physical Medicine and Rehabilitation (Dr Needham), Johns Hopkins University School of Medicine (Mr Yang), Baltimore, MD; Department of Mental Health (Dr Bienvenu), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and Medicine, Pulmonary, and Critical Care (Dr Hopkins), Intermountain Medical Center, and Psychology and Neuroscience Center, Brigham Young University, Salt Lake City, UT.

Correspondence to: O. Joseph Bienvenu, MD, PhD, 600 N Wolfe St, Meyer 115, Baltimore, MD 21287; e-mail: jbienven@jhmi.edu


Funding/Support: This research was supported by the National Institutes of Health [Grants HL73994, R01 HL88045, and R01 HL091760].

For editorial comment see page 1

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(1):24-31. doi:10.1378/chest.12-0908
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Background:  Survivors of acute lung injury (ALI) and other critical illnesses often experience substantial posttraumatic stress disorder (PTSD) symptoms. However, most questionnaires have not been validated against a PTSD diagnostic reference standard in this patient population. Hence, in the current study of survivors of ALI, we evaluated the Impact of Events Scale-Revised (IES-R), a questionnaire measure of PTSD symptoms, against the Clinician-Administered PTSD Scale (CAPS), the current state-of-the-art PTSD diagnostic reference standard, which also provides a quantitative assessment of PTSD symptoms.

Methods:  We evaluated the IES-R questionnaire vs the CAPS diagnostic interview in 60 of 77 consecutively recruited survivors of ALI from two prospective cohort studies of patients 1 to 5 years after ALI.

Results:  The IES-R total score (range: 0.0-3.2) and the CAPS total severity score (range: 0-70) were strongly related (Pearson r = 0.80, Spearman ρ = 0.69). Using CAPS data, eight of the 60 patients (13%) had PTSD at the time of assessment, and an additional eight patients had partial PTSD (total prevalence, 27%). In a receiver operating characteristics curve analysis with CAPS PTSD or partial PTSD as criterion variables, the area under the curve ranged from 95% (95% CI, 88%-100%) to 97% (95% CI, 92%-100%). At an IES-R threshold of 1.6, with the same criterion variables, sensitivities ranged from 80% to 100%, specificities 85% to 91%, positive predictive values 50% to 75%, negative predictive values 93% to 100%, positive likelihood ratios 6.5 to 9.0, negative likelihood ratios 0.0 to 0.2, and efficiencies 87% to 90%.

Conclusions:  The IES-R appears to be an excellent brief PTSD symptom measure and screening tool in ALI survivors.

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