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Evaluation of the Pediatric Trauma Triage Checklist as a prehospital pediatric trauma triage tool for the state of Florida.

INTRODUCTION: Triage of injured children poses a significant challenge for prehospital care providers because there is not single trauma triage tool in use that has been developed specifically for children. The pediatric trauma score (PTS) probably is the single most studied and tested trauma triage tool developed solely for the pediatric population, and is an effective predictor of both severity of injury and potential mortality in injured children. However, the pediatric trauma score has been found to be an ineffective prehospital triage tool because it is not "user friendly" for field personnel. As such, the PTS has been modified to generate the more user-friendly "pediatric trauma triage checklist (PTTC)." METHODS: This study retrospectively reviewed 106 prehospital run reports to determine whether the patient met one or more of the criteria in the PTTC. By applying the MacKenzie algorithm to outcome data for each case, it was possible to determine whether the patient should have been sent to a trauma center. RESULTS: The PTTC demonstrated a sensitivity of 86.2%, a specificity of 41.6%, and an accuracy of 66.0% The PTTC demonstrated an overtriage rate of 58.3% and an undertriage rate of 13.8% When compared with a previous study, the PTTC demonstrated a 74% increase in overtriage. However, the 59% reduction in undertriage is more important. CONCLUSIONS: Use of the PTTC appears to have merit as a pediatric prehospital trauma triage tool but further study is recommended. The PTTC should be tested in a prospective, multiregional study involving a sample size sufficient to reach statistical significance.

Algorithms↗

The application of "dysexecutive syndrome" measures across cultures: performance and checklist assessment in neurologically healthy and traumatically brain-injured Hong Kong Chinese volunteers.

Deficits in planning, self-regulation and attention are a relatively common consequence of traumatic brain injury (TBI). Such "dysexecutive" deficits tend to be most exposed in complex, real world situations. Consequently, clinicians often have to rely on interviews, questionnaires and observation in their assessments. While there is little doubt that dysexecutive symptoms occur across different cultures, the expression of those symptoms, the way in which they are experienced by others, and the propensity of friends/relatives to report negative features may vary considerably. The cross-cultural use of standardized checklists and measures that have predominantly been studied with English speaking, Western groups therefore requires empirical support. Here a group of 68 healthy Chinese speaking volunteers were asked to complete translations of 2 UK developed questionnaires (the Dysexecutive Questionnaire and Cognitive Failures Questionnaire) measures and to perform 2 "executive" tasks (The Six Elements Test and the Tower of Hanoi). Their self ratings and the ratings of close relatives were very close to those seen in the original UK standardization samples--as was their performance on the 2 tasks. Accordingly, the conditions for assessing their clinical sensitivity were met. Comparison between 30 Chinese patients with TBI and matched controls showed that both questionnaires and tests were sensitive to the deficits in this group.

Adult↗

Psychosocial status after pediatric traumatic brain injury: a subtype analysis using the Child Behavior Checklist.

This study identified subtypes of psychosocial functioning in children who had sustained traumatic brain injury (TBI). Child Behavior Checklist (CBCL) profiles for 92 participants, aged 12 to 18 years, who had sustained a mild, moderate, or severe TBI were subjected to Q-Factor analysis. Sixty-four of the participants (75%) were classified into a four-category psychosocial typology labelled Normal (n = 32), Attention (n = 14), Delinquent (n = 10), and Withdrawn-Somatic (n = 8). This typology was found to overlap in part with previous TBI psychosocial typology (Butler et al., 1997), and with three of the clinical profile types derived by Achenbach (1993) for the CBCL. The majority of participants, including those who sustained severe TBI, were assigned to the Normal subtype and the overall level of psychosocial deviance was relatively mild in the other three subtypes. The results of this study support previous typology efforts and confirm the heterogeneous presentation of social and emotional functioning following TBI.

Adaptation, Psychological↗

The Child Behavior Checklist for group care workers: a study regarding the factor structure.

In this study we examined the factor structure of the Child Behavior Checklist (CBCL) filled out by group care workers. Group care workers' judgements were collected on 846 children and adolescents treated in various residential settings in The Netherlands. Using confirmatory factor analysis, we were able to show that the original CBCL factor model based on parental judgments of child behavior also fits for the judgments of group care workers. This means that the well known 8 narrow-band syndromes (Withdrawn, Somatic Complaints, etc.) as well as the 2 broad-band syndromes (Internalizing and Externalizing) can be used to interpret the CBCL scores of group care workers. This confirmation of the CBCL factor structure is a first step to add a group care worker version to the CBCL family. However, as a second step, normative data need to be gathered to further enhance the use of the CBCL for group care workers.

Adolescent↗

PTSD scale of the Child Behavior Checklist: concurrent and discriminant validity with non-clinic-referred sexually abused children.

Several assessment instruments include measures that are purported to assess characteristics of posttraumatic stress disorder (PTSD). Although these measures are used often by researchers and clinicians, few are supported by extensive validity data. The PTSD scale of the Child Behavior Checklist (CBCL) is one that has not yet encountered significant challenges to its validity. We examine the concurrent and discriminant validity of the CBCL-PTSD scale. Participants included 63 non-clinic-referred sexually abused (SA) children, 60 non-SA psychiatric outpatient children, and 61 non-SA, non-clinic-referred schoolchildren. Results revealed questionable concurrent validity for this scale, and suggest poor discriminant validity between SA children and non-SA psychiatric outpatients.

Adolescent↗

Quality of life assessment in a cross-cultural context: use of the Rotterdam Symptom Checklist in a multinational randomised trial comparing CMF and Zoladex (Goserlin) treatment in early breast cancer.

AIM: The aim of the study is to investigate quality of life (QoL) in the context of a multinational trial. The questions addressed are: is the Rotterdam Symptom Checklist (RSCL) 1) feasible and 2) reliable in cross cultural research, 3) is earlier validation confirmed in a multinational trial and 4) are there systematic differences in QoL across cultures? PATIENTS AND METHODS: Patients with histologically confirmed stage II, node positive breast cancer, were randomised in a multinational trial (the 'ZEBRA-study') comparing standard chemotherapy (CMF) or temporary ovarian ablation by treatment with a LHRH analogue (Zoladex, Goserlin). Patients originating from 13 countries completed a QoL questionnaire at baseline and three months after the start of treatment. RESULTS: 1) The questionnaire was completed by 689 patients at the first and 544 at the second measurement (response 78% and 68% respectively). The proportion of missing data was < 2.5% for 87.8% and 92.7% of the items at the respective time points. 2) Reliabilities of the physical and psychological distress scale were ranging from 0.68 to 0.90 across cultures. Reliability of the activity scale ranged from 0.42 to 0.89. 3) The structure at baseline was in agreement with the two factor structure proposed earlier. 4) Cross-cultural comparison indicated a systematic difference in QoL across cultures (P = 0.0028-< 0.0001) as well as a difference in change across cultures. CONCLUSIONS: QoL assessment using the RSCL proved feasible in the context of multinational clinical trials. Psychometric qualities were satisfactory. Systematic differences in QoL were found between cultures. This finding implies that in multinational clinical trials, treatment comparisons with respect to QoL should carefully account for a differential impact of cultures on the results.

Adult↗

A checklist for critiquing treatment fidelity studies.

My assignment was to critique and integrate the previous papers. I have organized this paper as follows: (1) a description and rationale for a checklist which can be used in judging the quality of a fidelity measure; (2) a critique of the Schaedle and Epstein paper; (4) a critique of the Lucca paper; and (4) a review of the paper by Bond, Evans, Salyers, Williams, and Kim.

Humans↗

The ability of the Symptom Checklist SCL-90 to differentiate various anxiety and depressive disorders.

We studied the use of the Symptom Checklist-90 (SCL-90) to differentiate between specific anxiety and depressive disorders and/or their symptoms in 280 patients with 6 DSM-III-R diagnoses: major depression (MD), panic disorder (PD), generalized anxiety disorder (GAD), social phobia (SP), obsessive-compulsive disorder (OCD), and mixed anxiety and depression (MAD). Using a comparison group, we found specific patterns for some of the diagnostic categories. Both the MD and MAD subjects had significantly high paranoid ideation, interpersonal sensitivity, hostility, and psychoticism, as well as high depression subscale scores; those with PD and GAD has the highest anxiety and somatization scores; and those with SP or OCD had a mixed pattern. When ranking the severity of psychopathology, the disorders ordered from most to least were MAD, MD, PD, GAD, SP, and OCD. Subsyndromal levels of symptoms frequently were associated with the various conditions. Use of the SCL-90 subscale helps to enlarge our understanding of the various anxiety and depressive disorders.

Adolescent↗

Exploration of psychometric properties of the developmental behavior checklist.

The Developmental Behavior Checklist (DBC; Einfeld & Tonge, 1995) is one of a very small number of psychopathology assessment instruments designed specifically for use with children and adolescents with mental retardation. In the present study, a factor analysis of the DBC was performed using a sample of 531 children and adolescents. This analysis revealed a factor structure sharing a good deal of overlap with the factor analyses of the DBC's developers. Furthermore, the high levels of internal consistency of the DBC subscales were replicated. Further research and development is needed on the DBC and other instruments for children and adolescents with mental retardation.

Adolescent↗

Assessing emotional and behavioral problems in children with intellectual disability: revisiting the factor structure of the developmental behavior checklist.

The objective of the reported study was to reassess the factor structure of the Developmental Behaviour Checklist (DBC) in a large cross-cultural sample representing all levels of intellectual disability. Parent and teacher DBC ratings on a combined sample of 1536 Dutch and Australian children and adolescents (ages 3-22) with mild to profound intellectual disability were used. Principal components analyses produced five subscales: Disruptive/Antisocial, Self-Absorbed. Communication Disturbance, Anxiety, and Social Relating, explaining 43.7% of the total variance. Internal consistencies of these subscales ranged from .66 to .91. The revised factor structure of the DBC appears to be an improved and useful tool for assessing emotional and behavioral problems in children with intellectual disabilities.

Adolescent↗

Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: is small beautiful?

The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioral screening questionnaire that can be completed in 5 minutes by the parents or teachers of children aged 4 to 16; there is a self-report version for 11- to 16-year-olds. In this study, mothers completed the SDQ and the Child Behavior Checklist (CBCL) on 132 children aged 4 through 7 and drawn from psychiatric and dental clinics. Scores from the SDQ and CBCL were highly correlated and equally able to discriminate psychiatric from dental cases. As judged against a semistructured interview, the SDQ was significantly better than the CBCL at detecting inattention and hyperactivity, and at least as good at detecting internalizing and externalizing problems. Mothers of low-risk children were twice as likely to prefer the SDQ.

Child↗

Sensitivity and specificity of the PTSD checklist in detecting PTSD in female veterans in primary care.

PTSD affects a substantial number of women in medical settings and is associated with significant distress and impairment. There are effective methods of treating trauma-related distress, but a minority seek such care. Thus, primary care is an important setting in which to identify individuals with PTSD. We sent questionnaires, including the PTSD Checklist--Civilian Version (PCL-C), to 419 female veterans who were seen in our primary care clinic in 1998; 56% (N = 221) returned the measures. A random subset (n = 49) was interviewed to establish psychiatric diagnoses. The results provide qualified support for the use of the PCL-C total score with a lowered cutoff score as a screening measure for PTSD in female veterans in primary care.

Adult↗

Validation of the PTSD Checklist-Civilian Version in survivors of bone marrow transplantation.

Life-threatening illness now qualifies as a precipitating stessor for posttraumatic stress disorder (PTSD). We examined the validity of the PTSD Checklist-Civilian Version (PCL-C; Weathers, Litz, Herman, Juska, & Keane, 1993), a brief 17-item inventory of PTSD-like symptoms, in a sample of 111 adults who had undergone bone marrow transplantation an average of 4.04 years previously. Exploratory factor analysis of the PCL-C identified four distinct patterns of symptom responses: Numbing-Hyperarousal, Dreams-Memories of the Cancer Treatment, General Hyperarousal, Responses to Cancer-Related Reminders and Avoidance-Numbing. Respondents meeting PTSD symptom criteria on the PCL-C had significantly lower physical, role, and social functioning, greater distress and anxiety, and significantly more intrusive and avoidant responses than individuals who did not meet PTSD symptom criteria.

Activities of Daily Living↗

Health-related quality of life in patients with systemic lupus erythematosus: development and validation of a lupus specific symptom checklist.

Reliable and sensitive measures are needed to evaluate the quality of life (QoL) in patients with systemic lupus erythematosus (SLE). No lupus specific questionnaires are available. This study describes the development and validation of a disease-specific questionnaire for lupus patients, which assesses the presence and burden of 38 disease- and treatment-related symptoms: the SLE Symptom Checklist (SSC). Reliability and reproducibility were tested in respectively 87 and 28 stable SLE patients. The internal consistency (Cronbach's alpha coefficients 0.89) and test-retest reliability (Pearson product-moment correlation coefficient between 0.67 and 0.87) were satisfactory. Concurrent validity was supported by significant, but moderate correlations with other measures of subjective well-being and functional status. Responsiveness was measured in 17 patients with lupus nephritis treated with cyclophosphamide, at start of therapy and 1 year thereafter. A significant change in number of symptoms and total distress level was found. It is concluded that the SSC has satisfactory psychometric properties and appears suitable for both clinical and research purposes.

Female↗

Psychometric properties of the PTSD Checklist-Civilian Version.

We examined the psychometric properties of the PTSD Checklist (PCL), a self-report instrument designed to assess symptoms of posttraumatic stress disorder. Three hundred ninety-two participants recruited in a university setting completed the PCL in addition to several well-established self-report instruments designed to assess various forms of psychopathology (e.g., depression, general anxiety, PTSD). Ninety participants returned for readministration of selected measures. Findings provided support for psychometric properties of the PCL, including internal consistency, test-retest reliability, convergent validity, and discriminant validity. Additional strengths of the PCL are discussed.

Adolescent↗

A comparison of speaking and mute individuals with autism and autistic-like conditions on the Autism Behavior Checklist.

The item, total, and subscale scores on the Autism Behavior Checklist (ABC) were compared for 155 mute and 335 speaking individuals with autism spectrum disorders. Although no significant difference was observed between the groups on the ABC total score, the mute group demonstrated significantly more pathology on 21 of 57 items and 3 of 5 subscales. The speaking group obtained significantly higher scores on only 8 items and 1 subscale (Language). The appropriateness of providing greater pathology scores on expressive language items to speaking, rather than to mute, individuals is called into question. The authors speculate whether the expressive language items are weighted too heavily, in regard both to the Language subscale and to the ABC total score. If the expressive language items were removed, the mute group would have significantly higher ABC total scores and therefore a greater degree of autism severity.

Adolescent↗

Subfactors of DSM-IV conduct disorder: evidence and connections with syndromes from the Child Behavior Checklist.

Is conduct disorder (CD) as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) a unitary entity, or do variants of CD exist? We addressed this question, using data collected from the parents of 1,669 Australian boys, aged 6-17. Parents were interviewed to assess DSM-IV Conduct Disorder (DSM-IV CD) criteria. Results revealed 2 subfactors of DSM-IV CD symptoms, made up of overt behaviors (e.g., initiating physical fights) and covert behaviors (e.g., stealing without confrontation). Ordinary least squares regressions showed the 2 CD subfactors to be significantly and uniquely predicted by Child Behavior Checklist (CBCL; T. M. Achenbach, 1991a, 1991b) syndromes labeled Aggressive Behavior and Delinquent Behavior, respectively. The results are discussed in terms of the utility of differentiating these 2 variants of CD in future editions of the DSM.

Antisocial Personality Disorder↗

Agreement between parents and teachers on behavioral/emotional problems in Japanese school children using the child behavior checklist.

We investigated the agreement between Japanese parents' and teachers' ratings concerning their children's behavioral/emotional problems. Mothers (n = 276) and teachers (n = 19) assessed each child (n = 316; 6 to 12 years old ) using Japanese parent and teacher version of the Child Behavior Checklist. Parent-teacher agreement were examined through three indices; mean scores, correlations and D scores (generalized distance between item profile). Mean scores rated by parents were significantly higher than those by teachers. The differences of parents' ratings according to sex of the child or parents' occupational level, and those of teachers' ratings according to sex of the child were consistent with previous Western studies. Parent-teacher correlations were in the low to middle range (0.16-0.36). We obtained significant sets of independent variables accounting for the variance of D scores, but the effect size of these variables was small. These results indicated that, as seen in Western studies, Japanese parents and teachers would also assess their child's problems differently and the child's demographics affect their evaluation. For further research, parent and teacher characteristics which may influence on their perspective of the child's problems could be examined.

Child↗