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Updated: May 26, 2026

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Screening for risk of persistent posttraumatic stress in injured children and their parents

Flaura K Winston1, Nancy Kassam-Adams, Felipe Garcia-España

  • 1Division of General Pediatrics, Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia, USA. flaura@mail.med.upenn.edu

JAMA
|August 7, 2003
PubMed

Insights

A new screening tool, the Screening Tool for Early Predictors of PTSD (STEPP), effectively identifies children and parents at risk for posttraumatic stress disorder after injury. This tool aids clinicians in allocating mental health resources efficiently.

Area of Science:

  • Pediatric trauma care
  • Childhood mental health
  • Trauma-informed care

Background:

  • Childhood injury is a significant health threat and a common cause of posttraumatic stress disorder (PTSD).
  • Many injured children with PTSD remain undiagnosed and untreated, highlighting a critical gap in care.

Purpose of the Study:

  • To develop a brief, stand-alone screening tool for use in acute trauma settings.
  • To identify injured children and their parents at risk for persistent posttraumatic stress symptoms.

Main Methods:

  • The Screening Tool for Early Predictors of PTSD (STEPP) was developed from a risk factor survey.
  • A prospective cohort study involved 269 children (aged 8-17) and their parents treated for traffic injuries.
  • PTSD symptoms were assessed using established scales at least 3 months post-injury.

Main Results:

  • The STEPP includes 4 questions for the child, 4 for the parent, and 4 from the medical record.
  • It demonstrated high sensitivity (0.88 for children, 0.96 for parents) and negative predictive values (0.95 for children, 0.99 for parents).
  • STEPP significantly predicted persistent traumatic stress in both children and parents.

Conclusions:

  • The STEPP is a novel, evidence-based tool for clinicians managing scarce mental health resources.
  • Its brevity and simple scoring facilitate administration in acute care settings.
  • This tool supports timely and appropriate allocation of mental health support for pediatric trauma survivors.
Abstract

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