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Posttraumatic stress symptoms (PTSS) are common following traumatic stress exposure (TSE). Identification of individuals with PTSS risk in the early aftermath of TSE is important to enable targeted administration of preventive interventions. In this study, we used baseline survey data from two prospective cohort studies to identify the most influential predictors of substantial PTSS. Self-identifying black and white American women and men ( = 1546) presenting to one of 16 emergency departments (EDs) within 24 h of motor vehicle collision