Preliminary Investigation of the Panic Screening Score for Emergency Department Patients With Unexplained Chest Pain

Abstract

Objectives:The objective was to demonstrate the derivation and the preliminary validation of a brief screening score to improve recognition of panic-like anxiety in emergency department (ED) patients with unexplained chest pain.Methods: This cross-sectional study included 507 ED patients with unexplained chest pain randomly assigned to the derivation condition (n = 201) or the validation condition (n = 306). The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) acted as the criterion standard for panic diagnosis. Receiver operating characteristic (ROC) curves were used to determine which of the sociodemographic, medical, and questionnaire response variables best predicted the presence of panic-like anxiety in the derivation condition. The selected predictors were entered in a logistic regression analysis to determine variables to be included in the screening score. The predictive validity of the resulting score was evaluated in both conditions. Results:The four-item Panic Screening Score (PSS) identified panic-like anxiety with a sensitivity of 63% (95% confidence interval [CI] = 52% to 73%) and a specificity of 84% (95% CI = 76% to 90%) in the derivation phase. The positive predictive value was 74% (95% CI = 62% to 93%) and the negative predictive value was 76% (95% CI = 68% to 89%). In the validation phase, the sensitivity and specificity were 53% (95% CI = 44% to 62%) and 85% (95% CI = 78% to 89%), respectively. The positive predictive value was 72% (95% CI = 62% to 80%) and the negative predictive value was 71% (95% CI = 65% to 77%).

A prospective cohort study to refine and validate thePanic Screening Scorefor identifying panic attacks associated with unexplained chest pain in the emergency department

“…We have shown that the PSS is eight times more sensitive in detecting PLA associated with UCP than is clinical evaluation by an emergency physician 373 In addition, the PSS offers a good combination of sensitivity and specificity (table 1) and these properties have been shown to be stable in a retrospective validation and preliminary prospective validation 7375 As of now, the PSS is the briefest and most effective screening instrument for PLA associated with UCP in emergency settings.…”

“…First, the PLA predictors that were valuable but not essential in previous studies will be reassessed 73. Next, the potential predictors of PLA that were not assessed at the time of the initial study will be evaluated.…”

“…Additional predictors for the refinement phase (objective 1): Additional predictors include the four potential predictors of PLA identified but not included in the final version of the PSS,73 as well as the items selected following a pilot study 75 and a review of the literature: Fear of dying associated with chest pain;85 86Item number 4 (fear of fainting) of the Anxiety Sensitivity Index87 88;Item number 28 (feeling overwhelmed by one's problems) on the State-Trait Anxiety Inventory;89 90The Autonomic Nervous System Questionnaire 91;The four panic disorder items from the Patient Health Questionnaire-15;92 these items were selected because they demonstrated sensitivity and specificity between 75% and 96% for PLA in patients in primary care and psychosomatic settings93;The modified version of the Life Events Stress Scale 9495 This scale has an excellent internal consistency (0.87).…”

“…73 In addition, the PSS offers a good combination of sensitivity and specificity (table 1) and these properties have been shown to be stable in a retrospective validation and preliminary prospective validation 7375 As of now, the PSS is the briefest and most effective screening instrument for PLA associated with UCP in emergency settings. Although the PSS has good specificity, its sensitivity needs to be improved (table 1).…”

“…74 One instrument, the Panic Screening Score (PSS; figure 1), was designed for use with patients with UCP and identifies panic attacks with and without panic disorder 73. In addition, the PSS has the advantage of being brief (four items) and easy to use.…”