The Test Accuracy of the Screening Tool For Early Predictors of PTSD (STEPP) for Post-Injury Mental Health in a Managed-Medicaid Population
*Lindsay A Buchanan1, Tara A McCarthy2, Songzhu Zhao3, Erinn M Hade3, Kylie M Bushroe3, *Julie C Leonard4
1Nationwide Children's Hospital, Columbus, OH;2The Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH;3The Ohio State University College of Medicine, Columbus, OH;4Nationwide Children's Hospital, The Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, The Ohio State University College of Medicine, Columbus, OH
BACKGROUND: Our purpose was to determine the test accuracy of the STEPP in identifying children with new mental health diagnoses and new psychotropic medications after unintentional, non-fatal injuries in a managed-Medicaid population. METHODS: We conducted a secondary analysis of a retrospective cohort that investigated mental health diagnoses and psychotropic medications pre- and post-injury in children ≤18 years treated at a pediatric trauma center from 2005 to 2015 (n=2208). Children were included in the parent study if enrolled in the hospital’s managed-Medicaid program at admission and for at least one healthcare visit the preceding year. For this study, we analyzed children with STEPP scores from their injury admission (n=85). Scores were grouped as test positive (child scores ≥ 4, parent scores ≥ 3) or negative (child score<4, parent score <3). For children without previous mental health diagnoses or psychotropic medication use, we calculated the sensitivity, specificity, and positive and negative predictive values for the child and parent STEPP. RESULTS: Of 78 children without previous diagnoses, 12 had post-injury mental health diagnoses. Of 68 children without previous psychotropic medication use, 10 had psychotropic medications prescribed post-injury. See Figure. CONCLUSIONS: We found that the STEPP performed poorly in identifying children who received new mental health diagnoses and new psychotropic medications following injury. There is a need for larger, multi-centered studies that evaluate the STEPP in identifying post-injury mental health needs.
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