Intensive longitudinal assessment following index trauma to predict development of PTSD using machine learning.

Journal: Journal of anxiety disorders
Published Date:

Abstract

There are significant challenges to identifying which individuals require intervention following exposure to trauma, and a need for strategies to identify and provide individuals at risk for developing PTSD with timely interventions. The present study seeks to identify a minimal set of trauma-related symptoms, assessed during the weeks following traumatic exposure, that can accurately predict PTSD. Participants were 2185 adults (Mean age=36.4 years; 64% women; 50% Black) presenting for emergency care following traumatic exposure. Participants received a 'flash survey' with 6-8 varying symptoms (from a pool of 26 trauma symptoms) several times per week for eight weeks following the trauma exposure (each symptom assessed ∼6 times). Features (mean, sd, last, worst, peak-end scores) from the repeatedly assessed symptoms were included as candidate variables in a CART machine learning analysis to develop a pragmatic predictive algorithm. PTSD (PCL-5 ≥38) was present for 669 (31%) participants at the 8-week follow-up. A classification tree with three splits, based on mean scores of nervousness, rehashing, and fatigue, predicted PTSD with an Area Under the Curve of 0.836. Findings suggest feasibility for a 3-item assessment protocol, delivered once per week, following traumatic exposure to assess and potentially facilitate follow-up care for those at risk.

Authors

  • Adam Horwitz
    Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA. Electronic address: ahor@umich.edu.
  • Kaitlyn McCarthy
    Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA.
  • Stacey L House
    Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
  • Francesca L Beaudoin
    Department of Epidemiology, Brown University, Providence, RI 02930, USA; Department of Emergency Medicine, Brown University, Providence, RI 02930, USA.
  • Xinming An
    Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, USA.
  • Thomas C Neylan
    Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA 94143, USA.
  • Gari D Clifford
    Department of Biomedical Informatics, Emory University, Atlanta, GA, United States.
  • Sarah D Linnstaedt
    Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, USA.
  • Laura T Germine
    Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA 02478, USA; The Many Brains Project, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.
  • Scott L Rauch
    Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA; Department of Psychiatry, McLean Hospital, Belmont, MA 02478, USA.
  • John P Haran
    Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA.
  • Alan B Storrow
    Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.
  • Christopher Lewandowski
    Department of Emergency Medicine, Henry Ford Health System, Detroit, MI 48202, USA.
  • Paul I Musey
    Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
  • Phyllis L Hendry
    Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL 32209, USA.
  • Sophia Sheikh
    Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL 32209, USA.
  • Christopher W Jones
    Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ. Electronic address: jones-christopher@cooperhealth.edu.
  • Brittany E Punches
    Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH 43210, USA; Ohio State University College of Nursing, Columbus, OH 43210, USA.
  • Robert A Swor
    Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA.
  • Lauren A Hudak
    Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA.
  • Jose L Pascual
    Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
  • Mark J Seamon
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
  • Erica Harris
    Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA 19107, USA.
  • Claire Pearson
    Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI 48202, USA.
  • David A Peak
    Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
  • Robert M Domeier
    Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI 48197, USA.
  • Niels K Rathlev
    Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA 01107, USA.
  • Paulina Sergot
    Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX 77030, USA.
  • Leon D Sanchez
    Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA 02115, USA.
  • Steven E Bruce
    Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO 63121, USA.
  • Jutta Joormann
    Department of Psychology, Yale University, New Haven, CT 06510, USA.
  • Steven E Harte
    Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
  • Karestan C Koenen
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
  • Samuel A McLean
    TRYUMPH Research Program, Departments of Anesthesiology and Emergency Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC.
  • Srijan Sen
    Psychiatry, University of Michigan.