After the ABCs

Abstract

Background: The effects of trauma do not end after resuscitation. The Screening Tool for Early Predictors of Post Traumatic Stress Disorder (STEPP) is validated for pediatric trauma victims and their parents. This would help identifying children and caregivers at risk for posttraumatic stress disorder (PTSD) and highlight mechanisms of trauma that increase risk.Methods: A retrospective review of 142 children and parents admitted to a Level I pediatric trauma center was completed. Variables of age, gender, injury severity score, and mechanism of injury were compared by Student's t test for normally distributed independent samples and chi-square for categorical variables. A p value of <.05 was considered significant.Results: Over 80% of eligible trauma patients and parents underwent a STEPP evaluation. More than 30% (n = 43) were positive. Positive pediatric evaluations were likely to be female; however, age and injury severity score between the two groups were not statistically significant. Although not statically significant, parental STEPP examinations were more likely to be positive than the screen of the injured child, which might have clinical significance. Pediatric STEPP evaluations were mostly positive after motor vehicle crashes and animal bites. Conclusion:The STEPP evaluation on pediatric trauma patients and parents is a valuable tool to screen for risk of PTSD. Certain mechanisms of injury resulted in higher rates of positive STEPP evaluations, yet limiting screening based on mechanisms of injury, age, or gender could result in delayed identification of PTSD risk. Screening parents is a key component of the STEPP evaluation, especially when there is discordance between the two.KEY WORDS: acute stress disorder, pediatric trauma, posttraumatic stress disorder, screening tool for early predictors of PTSD (STEPP)

Implementation of a standardized screening program for risk of posttraumatic stress disorder among youth hospitalized with injury.

“…Similar to a previous study that evaluated this screening program in the first year of implementation (Gill-Appiott & Murphy, 2015), the current findings offer evidence that such screening continues to be feasible 4 years after initiation of this program. As noted above, previous studies examining implementation of standardized screening, including the STEPP, found rates of completed screen between 12 and 86% (Hix-Small et al, 2007; Ward-Begnoche et al, 2006; Zebrack et al, 2015).…”

“…Despite high rates of screen completion, nearly 30% of eligible patients did not complete the screen, a finding similar to the roughly 20% of those who did not complete screens in a study of the initial implementation of this program (Gill-Appiott & Murphy, 2015). In addition, nearly 30% of patients who screened positively did not have a psychology consultation.…”

“…Additional empirical studies are needed to evaluate the relative role of these factors in facilitating screening and examining how these processes may support implementation of similar screening programs at other hospitals and in other types of settings, such as juvenile detention centers and schools. Despite high rates of screen completion, nearly 30% of eligible patients did not complete the screen, a finding similar to the roughly 20% of those who did not complete screens in a study of the initial implementation of this program (Gill-Appiott & Murphy, 2015). In addition, nearly 30% of patients who screened positively did not have a psychology consultation.…”

“…Empirically based cutoff scores for the STEPP are used to indicate need for inpatient psychology consultation for families at risk of developing PTSD. A previous study evaluating the initial implementation of this screening program suggests that standardized screening is feasible, as roughly 80% of those eligible completed the STEPP (Gill-Appiott & Murphy, 2015). The proposed study aimed to extend these findings by (a) evaluating the feasibility of completing psychology consultations during brief admissions, (b) comparing utilization of psychology services across those who were eligible compared with ineligible for the screening program and across those who were eligible but did or did not complete the screen, and (c) exploring characteristics of those who did and did not complete the screen and those identified as at risk based on the screen.…”