Journal of Rehabilitation Research & Development (JRRD)

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Volume 51 Number 8, 2014
   Pages 1203 — 1216

Abstract — Diagnostic accuracy of Posttraumatic Stress Disorder Checklist in ­blast-exposed military personnel

William C. Walker, MD;1–3* Scott D. McDonald, PhD;1,3–4 Laura Manning Franke, PhD1–3

1Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA; 2Defense and Veterans Brain Injury Center, Richmond, VA; 3Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Richmond, VA; 4Department of Psychology, Virginia Commonwealth University, Richmond, VA

Abstract — Researchers often extrapolate posttraumatic stress disorder (PTSD) status from PTSD Checklist (PCL) data. When doing so, cut points should be based on samples with similar characteristics. This study assessed PCL diagnostic accuracy and postconcussive symptom levels within 106 Iraq/Afghanistan war Veterans and servicemembers with recent blast exposure. Two definitions of PTSD were applied: (1) “strict” Diagnostic and Statistical Manual of Mental Health Disorders (DSM), 4th edition (DSM-IV) criteria and (2) “relaxed” DSM-IV criteria dropping the A2 criterion as per the DSM, 5th edition. Using a structured interview for PTSD, we found moderate agreement with the PCL. Under strict criteria, PTSD prevalence was 16%, PCL cut point was 66 at peak kappa, and mean Rivermead Postconcussion Questionnaire (RPQ) score trended higher for those with PTSD than for those without PTSD (35.5 +/– 11.2 vs 30.5 +/– 10.7, respectively; p = 0.08). Under relaxed criteria, PTSD prevalence was 26.4%, PCL cut point was 58 at peak kappa, and those with PTSD had higher RPQ scores than those without PTSD (36.4 +/– 11.2 vs 29.5 +/– 10.2, respectively; p = 0.003). Participants diagnosed with blast-related mild traumatic brain injury (n = 90) did not differ from those without mild traumatic brain injury (n = 16) in symptom scores. In conclusion, persons with combat-related blast exposure need higher than conventional PCL cut points and those with PTSD have more severe postconcussive-type symptoms than those without PTSD.

Key words: brain injury, concussion, diagnostic criteria, diagnostic errors, dual diagnosis, explosive blast, investigative techniques, medical history taking, military injury, posttraumatic stress disorder, sensitivity, specificity.


View HTML ¦ View PDF ¦ Contents Vol. 51, No.8

This article and any supplementary material should be cited as follows:
Walker WC, McDonald SD, Franke LM. Diagnostic accuracy of Posttraumatic Stress Disorder Checklist in blast-exposed military personnel. J Rehabil Res Dev. 2014;51(8):1203–16.
http://dx.doi.org/10.1682/JRRD.2013.12.0271
ResearcherID/ORCID: William C. Walker, MD: N-3162-2014; Scott D. McDonald, PhD: N-3799-2014; Laura Manning Franke, PhD: F-2670-2012
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