Screening for Risk of Persistent Posttraumatic Stress in Injured Children and Their Parents

Abstract

Context Injury, a leading health threat to children, is also a common cause of posttraumatic stress disorder (PTSD) in childhood. Most injured children with PTSD are not diagnosed or treated.Objective To develop a stand-alone screening tool for use by clinicians during acute trauma care to identify injured children and their parents who are at risk of significant, persistent posttraumatic stress symptoms. DesignThe Screening Tool for Early Predictors of PTSD (STEPP) was derived from a 50-item risk factor survey administered within 1 month of injury as part of a prospective cohort study of posttraumatic stress in injured children and their parents. Symptoms of PTSD were assessed at least 3 months after injury.Setting Urban, pediatric level I trauma center.Participants A sample of 269 children aged 8 to 17 years admitted for treatment of traffic-related injuries between July 1999 and October 2001, and one parent per child, completed a risk factor survey assessing potential predictors of PTSD outcome. One hundred seventy-one families (63%) completed a follow-up assessment. Main Outcome MeasuresThe Clinician-Administered PTSD Scale for Children and Adolescents and the PTSD Checklist served as criterion standards for child and parent outcomes, respectively. Positive cases were defined as those meeting criteria for at least subsyndromal PTSD with continuing impairment ("persistent traumatic stress"). ResultsThe STEPP contains 4 dichotomous questions asked of the child, 4 asked of one parent, and 4 items obtained easily from the emergency medical record. STEPP sensitivity in predicting posttraumatic stress was 0.88 for children and 0.96 for parents, with negative predictive values of 0.95 for children and 0.99 for parents. The odds ratio for prediction of persistent traumatic stress was 6.5 (95% confidence interval [CI], 1.8-22.8) in children and 26.6 (95% CI, 3.5-202.1) in parents. ConclusionsThe STEPP represents a new method to guide clinicians in making evidence-based decisions for the allocation of scarce mental health resources for traumatic stress. Its brevity and simple scoring rule suggest that it can be easily administered in the acute care setting.

Acute stress disorder and the transition to posttraumatic stress disorder in children and adolescents: Prevalence, course, prognosis, diagnostic suitability, and risk markers

“…PTSD may be chronic in youth, potentially lasting years (Morgan, Scourfield, Williams, Jasper, & Lewis, 2003; Yule et al., 2000). Given this potential for profound disruption of a young person's development, researchers have attempted to understand the etiology and evolution of chronic PTSD (Winston, Kassam‐Adams, & Garcia‐Espana, 2003), with a view to early intervention (Marsac, Donlon, & Berkowitz, 2014). …”

Parental Injury and Psychological Health of Children

“…Few injured children receive PTSD or other emotional health screening from their primary care providers in the weeks and months after exposure to injury events. Briefer screening tools for PTSD in children have been developed, 3 and their routine use should be examined. Automated screening for PTSD using known risk factors and characteristics of the index injury is also feasible.…”

“…High levels of posttraumatic stress disorder (PTSD) symptoms have been documented in 15% to 42% of injured adolescents after acute injury. [1][2][3] In 1 study, 27% of parents of injured adolescents reported symptoms consistent with a diagnosis of PTSD. 4 Whereas only 11% of the general population has experienced $4 traumatic life events (eg, motor vehicle crash injury, sudden death of immediate family member, violent assault with a gun or other injury), 30% of randomly sampled adolescents presenting with injuries and 40% of their parents reported experiencing $4 such traumatic life events before the index injury.…”

Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms

“…[149][150][151] Similarly, an 8-question screen was shown to have excellent predictive characteristics for detecting posttraumatic stress symptoms in children who sustained traffic-related injuries. 152 Given the clinical and time pressures of the ED setting, it is important that mental health screening be acceptable to adolescents, their parents, and ED clinicians. Numerous studies have shown the acceptability of such screening.…”