Immediate Stress Reaction Checklist (ISRC)

Background and development

The Immediate Stress Reaction Checklist was created to assess immediate post-trauma responses in youth and young adults (for example in the Emergency Department within hours of a traumatic event). In this time period, it is not appropriate to think of these responses as acute stress disorder; that diagnosis is made only when acute stress symptoms last for a minimum of 3 days and begin to impair the individual's functioning.

In a study of youth followed after Emergency Department treatment for violent injury, acute stress reactions assessed by the ISRC were predictive of longer-term traumatic stress symptoms (Fein et al 2002).

Fein, J., Kassam-Adams, N., Vu, T. & Datner, E. (2001). Emergency Department evaluation of Acute Stress Disorder symptoms in violently injured youths. Annals of Emergency Medicine, 38:391-396. doi: 10.1067/mem.2001.118225
Fein, J., Kassam-Adams, N., Gavin, M., Huang, R., Blanchard, D., & Datner, E. (2002) Persistence of post-traumatic stress in violently injured youth seen in the Emergency Department. Archives of Pediatrics and Adolescent Medicine, 156: 836–840. doi:10.1001/archpedi.156.8.836

The ISRC has also been used in studies of acute traumatic stress reactions in adult patients seen in the Emergency Department.

Price, M., Kearns, M., Houry, D., & Rothbaum, B. O. (2014). Emergency department predictors of posttraumatic stress reduction for trauma-exposed individuals with and without an early intervention. Journal of Consulting and Clinical Psychology, 82(2), 336. doi: 10.1037/a0035537

Use of the ISRC in prediction algorithms

ISRC data from Emergency Department studies with adult patients was incorporated in later work by Schultebraucks et al (2020, 2023) who used machine learning approaches to create predictive algorithms that were then validated in independent samples.

Schultebraucks, K., Shalev, A. Y., Michopoulos, V., Grudzen, C. R., Shin, S. M., Stevens, J. S., ... & Marmar, C. R. (2020). A validated predictive algorithm of post-traumatic stress course following emergency department admission after a traumatic stressor. Nature Medicine, 26(7), 1084-1088. doi: 10.1038/s41591-020-0951-z
Schultebraucks, K., Stevens, J. S., Michopoulos, V., Maples-Keller, J., Lyu, J., Smith, R. N., ... & Powers, A. (2023). Development and validation of a brief screener for posttraumatic stress disorder risk in emergency medical settings. General Hospital Psychiatry. doi: 10.1016/j.genhosppsych.2023.01.012

Language / translation:

The ISRC was developed in English. We are aware of efforts by other teams to translate the ISRC for use in Japanese, Hebrew, Arabic, and Spanish. If you are interested in learning more about this, or in translating the ISRC to additional languages, please contact the Center for Pediatric Traumatic Stress at cpts@chop.edu.

Information on ISRC items

The ISRC was developed when DSM-IV was current, thus items largely correspond to DSM-IV symptom criteria for traumatic stress responses, as follows:

DSM-IV CRITERION A2 FOR PTSD

3 items assess Fear / Helplessness / Horror (13, 14, 15)

PERI-TRAUMATIC DISSOCIATION (DURING THE TRAUMATIC EVENT)

3 items each assess

Numbing / Detachment (1, 8, 12)
Reduced awareness of surroundings (3, 4, 11)
Derealization (5, 7, 10)
Depersonalization (2, 6, 9)

ACUTE STRESS RESPONSES IN THE IMMEDIATE AFTERMATH

Re-experiencing symptoms (17, 21, 25)
Avoidance symptoms (18, 22, 26)
Hyperarousal symptoms (19, 23, 27)
Dissociative symptoms (16, 20, 24)

Note: The ISRC is not a measure of acute stress disorder (ASD) or of posttraumatic stress disorder (PTSD). You can find more information about recommended acute stress measures for children, youth, and adults here: https://healthcaretoolbox.org/find-screening-and-assessment-tools

How do I get a copy of the ISRC?

Download a copy of the ISRC and background information here.

ISRC - background and measure 2024.pdf (127.8 KB)

Do I need permission to use the ISRC?

Please register to use the Immediate Stress Reaction Checklist here, to help our team keep track of its use by others.

The Immediate Stress Reaction Checklist (ISRC) is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. CC-BY-NC 4.0

image of creative commons license

This means that you are free to use the ISRC, and to adapt and build upon the work non-commercially, as long as you acknowledge the ISRC and its original authors, ie citing the Fein et al 2001 reference above.

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