The casualty chain inventory: a new scale for measuring peritraumatic responses: a cross-sectional study

Three hundred and fifteen injured, conscious, hospitalised patients were assessed with a self-report questionnaire. The CCI consists of eight items including sensory impressions and well-known psychological responses to trauma.The internal consistency of the CCI was solid (Cronbach's alpha: .83-.85). A factor analysis revealed two components, "perception" and "dissociation". The instrument correlates significantly with the Impact of Event Scale (r = 0.47 - 0.54) and the Posttraumatic Stress Scale-10 (r = 0.32 - 0.50). The explained variance is high both at the scene of injury (61%) and in the hospital (65%). Dissociation and perception either used as a two-factor solution or as a sum score measured in the hospital, gave the strongest prediction for later psychological distress.The CCI appears to be a useful screening instrument for, at an early state, identifying patients hospitalized after a physical incident at risk for subsequent psychological distress.Patients who are hospitalized because of physical traumas may perceive varying degrees of psychological threat during the incident. A physical accident can be viewed as a chain of connected moments--the moment one realize that something bad is about to happen, when it happens, waiting for help, transportation to, and treatment in hospital. This process may be defined as the casualty chain. The authors of two meta-analyses recommended further research on peritraumatic responses [1,2]. ？zer et al. concluded that peritraumatic psychological processes might be the strongest predictors of posttraumatic stress disorder (PTSD). In order to get a diagnosis of posttraumatic stress disorder (PTSD), a high level of posttraumatic stress symptoms (PTS) must be present together with other diagnostic criteria.Most instruments are developed to measure posttraumatic stress, such as the Impact of Event Scale [3], the Trauma Screening Questionnaire [4], and the Post-traumatic Stress Scale-10 [5]. However, only few instruments measure