
A validated predictive algorithm of post-traumatic stress course following emergency department admission after a traumatic stressor
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ABSTRACT Annually, approximately 30 million patients are discharged from the emergency department (ED) after a traumatic event1. These patients are at substantial psychiatric risk, with
approximately 10–20% developing one or more disorders, including anxiety, depression or post-traumatic stress disorder (PTSD)2,3,4. At present, no accurate method exists to predict the
development of PTSD symptoms upon ED admission after trauma5. Accurate risk identification at the point of treatment by ED services is necessary to inform the targeted deployment of existing
treatment6,7,8,9 to mitigate subsequent psychopathology in high-risk populations10,11. This work reports the development and validation of an algorithm for prediction of post-traumatic
stress course over 12 months using two independently collected prospective cohorts of trauma survivors from two level 1 emergency trauma centers, which uses routinely collectible data from
electronic medical records, along with brief clinical assessments of the patient’s immediate stress reaction. Results demonstrate externally validated accuracy to discriminate PTSD risk with
high precision. While the predictive algorithm yields useful reproducible results on two independent prospective cohorts of ED patients, future research should extend the generalizability
to the broad, clinically heterogeneous ED population under conditions of routine medical care. Access through your institution Buy or subscribe This is a preview of subscription content,
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institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS A SYSTEMATIC REVIEW OF MACHINE LEARNING FINDINGS IN PTSD AND THEIR RELATIONSHIPS
WITH THEORETICAL MODELS Article 07 January 2025 A 20-YEAR LONGITUDINAL COHORT STUDY OF POST-TRAUMATIC STRESS DISORDER IN WORLD TRADE CENTER RESPONDERS Article 27 May 2025 DEVELOPMENT AND
VALIDATION OF A RISK PREDICTION MODEL FOR POST-TRAUMATIC STRESS DISORDER AMONG CHINESE BREAST CANCER SURVIVORS Article Open access 17 March 2025 DATA AVAILABILITY All requests for raw and
analyzed data and related materials, including programming code, will be reviewed by our legal departments (New York University Grossman School of Medicine and Emory University School of
Medicine) to verify whether the request is subject to any intellectual property or confidentiality constraints. Any data and materials that can be shared will be released via a material
transfer agreement for noncommercial research purposes. Request should be addressed to the corresponding author (K.S.) or the Principal Investigators of the two study sites (K.J.R. and
I.R.G.-L.). CODE AVAILABILITY The programming code is based on Scikit-learn (https://scikit-learn.org/stable/) and SHAP (https://github.com/slundberg/shap) and the core algorithm can be
obtained from https://github.com/KSchultebraucks/DeepSuperLearner. Requests should be addressed to the corresponding author (K.S.). REFERENCES * DiMaggio, C. J., Avraham, J. B., Lee, D. C.,
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and individual predictions with feature contributions. _Knowl. Inf. Syst._ 41, 647–665 (2014). Google Scholar Download references ACKNOWLEDGEMENTS K.S. was supported by the German Research
Foundation (SCHU 3259/1–1). The study was also supported by K01MH102415 (I.R.G.-L.), R01MH094759 (C.B.N.) and R01MH094757 (K.J.R.). AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department
of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA Katharina Schultebraucks, Arieh Y. Shalev, Charles R. Marmar & Isaac R. Galatzer-Levy * Vagelos School
of Physicians and Surgeons, Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA Katharina Schultebraucks * Data Science Institute, Columbia
University, New York, NY, USA Katharina Schultebraucks * Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA Vasiliki Michopoulos,
Jennifer S. Stevens, Jessica L. Maples-Keller, Barbara O. Rothbaum & Kerry J. Ressler * Yerkes National Primate Research Center, Atlanta, GA, USA Vasiliki Michopoulos * Ronald O.
Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA Corita R. Grudzen & Soo-Min Shin * Department of Psychiatry and Behavioral
Neurosciences, Wayne State University, Detroit, MI, USA Tanja Jovanovic * Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA George A.
Bonanno * Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY, USA Charles R. Marmar * Dell Medical School, Department of Psychiatry,
University of Texas at Austin, Austin, TX, USA Charles B. Nemeroff * Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA Charles B. Nemeroff * McLean
Hospital, Harvard Medical School, Boston, MA, USA Kerry J. Ressler * AiCure LLC, New York, NY, USA Isaac R. Galatzer-Levy Authors * Katharina Schultebraucks View author publications You can
also search for this author inPubMed Google Scholar * Arieh Y. Shalev View author publications You can also search for this author inPubMed Google Scholar * Vasiliki Michopoulos View author
publications You can also search for this author inPubMed Google Scholar * Corita R. Grudzen View author publications You can also search for this author inPubMed Google Scholar * Soo-Min
Shin View author publications You can also search for this author inPubMed Google Scholar * Jennifer S. Stevens View author publications You can also search for this author inPubMed Google
Scholar * Jessica L. Maples-Keller View author publications You can also search for this author inPubMed Google Scholar * Tanja Jovanovic View author publications You can also search for
this author inPubMed Google Scholar * George A. Bonanno View author publications You can also search for this author inPubMed Google Scholar * Barbara O. Rothbaum View author publications
You can also search for this author inPubMed Google Scholar * Charles R. Marmar View author publications You can also search for this author inPubMed Google Scholar * Charles B. Nemeroff
View author publications You can also search for this author inPubMed Google Scholar * Kerry J. Ressler View author publications You can also search for this author inPubMed Google Scholar *
Isaac R. Galatzer-Levy View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS I.R.G.-L., K.J.R, C.B.N., A.Y.S., C.R.M., B.O.R., V.M., T.J. and
K.S. substantially contributed to the design of the study and developed the study concept. S.-M.S., I.R.G.-L., V.M., J.S.S., J.L.M.-K., C.R.G. were involved in the data collection process.
K.S. developed the data analytical plan and performed data analysis. G.A.B. and I.R.G.-L. provided supervision. K.S. wrote the first draft of the manuscript and all co-authors reviewed and
revised the manuscript critically for important intellectual content. All co-authors approved the version of the manuscript to be published. CORRESPONDING AUTHOR Correspondence to Katharina
Schultebraucks. ETHICS DECLARATIONS COMPETING INTERESTS B.O.R. has funding from Wounded Warrior Project, Department of Defense Clinical Trial Grant No.W81XWH-10-1-1045, National Institute of
Mental Health grant no. 1R01MH094757-01 and McCormick Foundation. B.O.R. also receives royalties from Oxford University Press, Guilford, APPI and Emory University and received advisory
board payments from Genentech, Jazz Pharmaceuticals, Sophren, Nobilis Therapeutics, Neuronetics and Aptinyx. C.R.M. serves on the scientific advisory board and has equity in Receptor Life
Sciences. He also serves on the PTSD advisory board for Otsuka Pharmaceutical. He receives support from the National Institute on Alcohol Abuse and Alcoholism, National Institute of Mental
Health, Department of Defense, US Army Congressionally Directed Medical Research Program, the Steven & Alexander Cohen Foundation, Cohen Veterans Bioscience, Cohen Veterans Network, Home
Depot Foundation, McCormick Foundation, Robin Hood Foundation and the City of New York. C.B.N. discloses the following: research/grants from National Institutes of Health and Stanley
Medical Research Institute; consulting (last three years) at Xhale, Takeda, Taisho Pharmaceutical Inc., Bracket (Clintara), Fortress Biotech, Sunovion Pharmaceuticals Inc., Sumitomo
Dainippon Pharma, Janssen Research & Development LLC, Magstim, Inc., Navitor Pharmaceuticals, Inc., TC MSO, Inc. and Intra-Cellular Therapies, Inc.; stockholder of Xhale, Celgene,
Seattle Genetics, Abbvie, OPKO Health, Inc., Antares, BI Gen Holdings, Inc., Corcept Therapeutics Pharmaceuticals Company, TC MSO, Inc. and Trends in Pharma Development, LLC; scientific
advisory boards of American Foundation for Suicide Prevention (AFSP), Brain and Behavior Research Foundation, Xhale, Anxiety Disorders Association of America (ADAA), Skyland Trail, Bracket
(Clintara) and Laureate Institute for Brain Research Inc.; board of directors of AFSP, Gratitude America, ADAA and Xhale Smart, Inc.; income sources or equity of USD$10,000 or more from
American Psychiatric Publishing, Xhale, Bracket (Clintara), CME Outfitters, Takeda, Intra-Cellular Therapies, Inc., Magstim and EMA Wellness; patents for the method and devices for
transdermal delivery of lithium (US 6,375,990B1), the method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (US
7,148,027B2) and compounds, compositions, methods of synthesis and methods of treatment (CRF receptor binding ligand) (US 8,551,996 B2). K.J.R. performs consulting for Janssen, Verily,
Alkermes and Biogen, Inc. on matters unrelated to this manuscript. I.R.G.-L. receives salary and stock options from AiCure. All other authors declare no competing interests. ADDITIONAL
INFORMATION PEER REVIEW INFORMATION Kate Gao was the primary editor on this article, and managed its editorial process and peer review in collaboration with the rest of the editorial team.
PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EXTENDED DATA EXTENDED DATA FIG. 1 SCHEMATIC OVERVIEW
OF THE STUDY DESIGN. Displayed are the basic steps of the model development and model validation. EXTENDED DATA FIG. 2 PREDICTIVE PERFORMANCE IN TERMS OF DISCRIMINATION AND CALIBRATION. In
panel A, the ROC curve shows the specificity and the sensitivity of the predictions on the training set (blue line) and the external validation set (orange line) and is accompanied by a
calibration plot for the predicted probabilities on the training set (orange line and blue bars) and the external validation set (red line and green bars) in panel B. The bars in the
calibration plot in panel (B) displays the predicted probabilities in 10 bins [0, 10%], (10%, 20%],…, (90%, 100%], whereas the lines visualize the predicted probabilities in two bins (low
vs. high probability). SUPPLEMENTARY INFORMATION SUPPLEMENTARY INFORMATION Supplementary Figs. 1–7, Supplementary Tables 1–10, Supplementary Discussion. REPORTING SUMMARY RIGHTS AND
PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Schultebraucks, K., Shalev, A.Y., Michopoulos, V. _et al._ A validated predictive algorithm of post-traumatic stress
course following emergency department admission after a traumatic stressor. _Nat Med_ 26, 1084–1088 (2020). https://doi.org/10.1038/s41591-020-0951-z Download citation * Received: 16 July
2019 * Accepted: 22 May 2020 * Published: 06 July 2020 * Issue Date: July 2020 * DOI: https://doi.org/10.1038/s41591-020-0951-z SHARE THIS ARTICLE Anyone you share the following link with
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