New Tool Helps Doctors Predict PTSD Following a Child Injury; With a Few Questions, Doctors May Be Able to Predict Child and Parent Posttraumatic Stress Following a Child's Injury, According to Researchers at The Children's Hospital of Philadelphia

08/5/2003

PHILADELPHIA, Aug. 5 /PRNewswire/ -- Posttraumatic stress disorder (PTSD) in injured children and their parents is common, but under-diagnosed, following a child's traumatic injury. Researchers at The Children's Hospital of Philadelphia have developed a simple screening tool, involving specific questions asked at the initial treatment visit, that can help predict the likelihood of a child or parent developing persistent PTSD. The Screening Tool for Early Predictors of PTSD (STEPP) is described in the August 6 issue of the Journal of the American Medical Association.

"Until now, health care providers did not have a simple way to tell, early on, who could be at risk of PTSD after a child injury," said Flaura K. Winston, M.D., Ph.D., study co-author and director of TraumaLink at Children's Hospital. "We hope that acute care physicians can use this screening tool to help determine who should be referred for psychological evaluation and intervention so that families can avoid PTSD."

PTSD is a group of symptoms and reactions that occurs following a traumatic event that persist for a long time (at least one month) and impair an individual's everyday functioning. Symptoms include re-experiencing the trauma (unwanted and upsetting thoughts or memories), avoiding reminders of the trauma, and hyperarousal (jumpiness).

Through their ongoing research, Dr. Winston and her colleagues found that severity of injury is not necessarily a predictor of PTSD. Instead, a combination of event-related factors, early physiological reactions such as heart rate, and early psychological responses serves to predict future development of PTSD.

STEPP was developed in a population of children who had traffic-related injuries and their parents. The STEPP method includes four yes/no questions asked of the parent, four yes/no questions asked of the child, and four items easily obtained from medical records.

To create STEPP, researchers had 171 families complete a 50-question risk factor survey at the initial treatment and complete a three-month follow-up assessment. The STEPP questions were derived from the combination of responses from participants that most often predicted persistent posttraumatic stress at three months. For example, STEPP questions for children ask if they were separated from their parents or had been very afraid. Parent questions ask about feelings of helplessness and whether they had witnessed the child's injury.

Of children who screened positive, 25 percent went on to present with PTSD. Of children who screened negative only 5 percent developed PTSD. Of parents who screened positive, 27 percent developed PTSD symptoms compared to only one percent of parents who screened negative.

"While most parents and children do well following a traumatic injury, STEPP can help find those in need of psychological support," said Nancy Kassam-Adams, Ph.D., study co-author and associate director of behavioral research for TraumaLink at Children's Hospital. "In an environment where mental health resources are scarce, STEPP can serve as a triage tool for psychological referral and intervention."

After pediatric injury, parents can help children cope by talking with their child about what happened and listening carefully to the child's thoughts and feelings, according to Dr. Kassam-Adams. Parents also need to pay attention to their own reactions to the injury and seek support from family and friends.

The researchers say that after an injury parents can look out for signs that a child may be suffering from posttraumatic stress or PTSD: Are there changes in a child's school performance like a sudden decline in grades? Is the child showing new fears or worries, or avoiding things related to the injury? Is he or she having trouble sleeping or concentrating? Is the child jumpy or extra tearful? If bothersome reactions persist beyond a month following the traumatic event, parents should consider seeking help for their child.

Parents with questions about PTSD should speak with a trusted medical professional or visit the Web site of the National Center for Child Traumatic Stress at http://www.NCTSnet.org.

The study, funded by the Maternal and Child Health Bureau, is part of the Child and Adolescent Reactions to Injury and Trauma Research Program at TraumaLink, an interdisciplinary pediatric trauma research center at The Children's Hospital of Philadelphia.

Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked today as the best pediatric hospital in the nation by US News & World Report and Child magazines. Through its long- standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 381-bed hospital recognition as a leading advocate for children and adolescents from before birth through age 19. Children's Hospital operates the largest pediatric healthcare system in the U.S. with more than 40 locations in Pennsylvania, New Jersey and Delaware.

CONTACT: Suzanne Hill, Children's Hospital of Philadelphia, +1-267-426-6067 or Email: hillsu@email.chop.edu.