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Open Access Open Badges Research article

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

Laila Skogstad1*, Erlend Hem2, Leiv Sandvik3 and Øivind Ekeberg24

Author Affiliations

1 Department of Research and Development, Division of Critical Care, Oslo University Hospital, Ulleval, Norway

2 Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

3 Section of Epidemiology and Biostatistics, Oslo University Hospital, Ulleval, Norway

4 Department of Acute Medicine, Oslo University Hospital, Ulleval, Norway

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BMC Emergency Medicine 2011, 11:6  doi:10.1186/1471-227X-11-6

Published: 18 May 2011



Peritraumatic psychological- and sensory impressions in victims of civilian accidents are only partly understood. This study scrutinizes the level and duration of perceived psychological threat at scene of injury as well as in hospital (the casualty chain) measured by the Casualty Chain Inventory (CCI). The purpose of the study was to assess and validate the CCI, and to examine the correlations between the new instrument and stress responses measured by the Impact of Event Scale (IES) and the Post-traumatic Stress Scale-10 (PTSS-10)


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.