Development and Pilot Testing of a Five Item Traumatic Stress Screener for Use with Adolescents in Pediatric Primary Care

Objectives To develop and assess the psychometric properties of the Adolescent Primary Care Traumatic Stress Screen (APCTSS), a five-item yes/no screener for PTSD symptoms in adolescents, and the first developed for pediatric primary care. Study Design The APCTSS was developed by combining and adapting the UCLA PTSD Reaction Index for DSM-5 with the adult Primary Care PTSD Screen for DSM-5. Adolescent medicine patients were universally approached during clinic visits. With a response rate of 83.6%, 178 patients aged 13-22 (M=18.4, SD=2.3), 64.4% female; 62.1% Black or African-American and 20.7% Hispanic/Latinx, were enrolled. Patients completed APCTSS, Patient Health Questionnaire for Adolescents (PHQ-A), and Child PTSD Symptom Scale for DSM-5 Interview (CPSS-5-I), and 61 completed the Traumatic Events Screening Inventory for Children (TESI-C). Results 56.7% reported a criterion A trauma, 30.1% met criteria for PTSD, 7.4% met criteria for subsyndromal PTSD, and 19.0% for post-event impairing symptoms. Scores ≥ 2 on the APCTSS optimized sensitivity (.79; 95% CI=.66 to .89) and specificity (.68; 95% CI=.55 to .76) for PTSD, with an area under the curve (AUC) of .79. Sensitivity (.86; 95% CI=.65 to .90), specificity (.77; 95% CI=.60 to .90), and AUC (.86) were even stronger when the TESI-C was used to assess criterion A for PTSD diagnosis. Over half (56.0%) of patients who screened positive on the APCTSS were missed by the PHQ-A. Conclusions The APCTSS shows promise as an internally consistent, valid, and effective tool for identifying adolescents at high risk of PTSD and traumatic stress.