| Objective 1.To systematically evaluate the accuracy of the Post-traumatic stress disorder(PTSD)assessment tool in ICU survivors and to compare the accuracy of Impact of Events Scale-Revised(IES-R)and Post-Traumatic Stress Scale 10,PTSS-10)in assessing PTSD of ICU survivors for the purpose of providing a scientific assessment tool for assessing PTSD in patients after ICU treatment.2.To compare the difference of subjective sleep quality,objective sleep quality and cortisol secretion levels between PTSD positive group and PTSD negative group,Method 1.Cochrane systematic review of diagnostic test for screening and assessment tool of PTSD in ICU survivors was performed.Databases(including MEDLINE,EMBASE,CENTRAL,Psyc INFO,Open Grey,Wanfang,Weipu,CNKI,CBM and so on)were searched.Two reviewers independently identified trials,extracted data,and assessed the risk of bias of eligible studies using QUADAS-2.Meta-analysis was performed using R.Revman was used to draw summary of the receiver operating characteristic curve(SROC curve)to compare the area under the curve(AUC).2.PTSD symptoms were measured by IES-R and PTSS-10 in patients who discharged from cardiac surgical ICU of two tertiary referral hosiptals in Fuzhou.The Clinical administered PTSD Scale(CAPS)was used as the golden standard of PTSD diagnosis to compare the psychometric indicators of IES-R and PTSS-10.3.According to the results of IES-R total scores in the follow-up study,the patients were divided into two groups namely PTSD positive group(total score ≥35)and PTSD negative group.Pittsburgh sleep quality index(PSQI)and actigraphy were used to assessing the subjective sleep quality and objective sleep quality respectively.Noctural urine sample was collected and cortisol secretion levels were analysed by using Chemiluminescence immunoassay.Results 1.A systematic review of the PTSD assessment tool Five studies were included,involving 825 patients.The tools included IES-R,PTSS-10,IES,PDI and PSS-SR.The quality of the included studies was very low.Pooled incidence of IES-R and PTSS-10 were16.0%(95% CI: 4.0% ~ 50.0%,I2 = 95%)and 27.0%(95% CI: 21.0% ~ 35.0 %,I2 = 28.0%)respectively.There was significant heterogeneity among study estimates(P =0.000;I2 = 96.9%).The SROC curve showed that the AUC of IES-R is greater than that of PTSS-10.2.A comparative study of the PTSD assessment tool(1)Of the 87 patients completing the IES-R and PTSS-10 scale,41 were interviewed by CAPS.Among them,6 cases were diagnosed as PTSD.The incidence of PTSD was 14.63%.(2)Using CAPS as the golden standard,the cut-off value of IES-R was 35 points,the sensitivity was 83.33%,the specificity was 94.29%,and the area under the ROC curve was 0.85.The cut-off value of PTSS-10 was 30,the sensitivity was 50.00%,the specificity was 94.29%,and the area under the ROC curve was 0.69.The difference of area under the ROC curve of IES-R and PTSS-10 were significant(Z=2.01,P <0.05).3.Sleep quality and urinary cortisol in PTSD patients(1)Subjective sleep quality was significantly different between the two groups in terms of sleep quality,sleep time,sleep time,sleep efficiency,sleep disorders,hypnotic drugs,daytime functional scores and PSQI total scores(P <0.05).(2)There was no significant difference in sleep latency and bedtime between the two groups(P> 0.05).There were significant differences in sleep efficiency,total sleep time,awakening time after sleep,number of awakening after sleep and average awakening time(P <0.05).(3)There was no significant difference of cortisol level between PTSD positive group and PTSD negative group(t=0.404,P﹥0.05).Conclusion: 1.Based on the available evidence,IES-R may be the tool of highest accuracy for PTSD assessment in ICU survivors.However,due to the small number of studies,poor quality and heterogeneity,the results should be treated with caution.The quality of the diagnostic tests is to be improved.2.Prospective study suggested that the accuracy of IES-R to identify PTSD of ICU survivors was higher than that of PTSS-10.3.The quality of subjective and objective sleep quality in patients with PTSD positive group was worse than that in PTSD negative group. |
