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Chest. 2013 Jul;144(1):24-31. doi: 10.1378/chest.12-0908.

Posttraumatic stress disorder in survivors of acute lung injury: evaluating the Impact of Event Scale-Revised.

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Department of Psychiatry and Behavioral Sciences, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Group, Baltimore, MD; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. Electronic address:
Department of Psychiatry and Behavioral Sciences, Baltimore, MD.
Johns Hopkins University School of Medicine, Baltimore, MD.
Medicine, Pulmonary, and Critical Care, Intermountain Medical Center, and Psychology and Neuroscience Center, Brigham Young University, Salt Lake City, UT.
Outcomes After Critical Illness and Surgery (OACIS) Group, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Baltimore, MD.



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.


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.


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%.


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

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