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Screening for post-traumatic stress disorder after injury in the pediatric emergency department--a systematic review
Jeffrey Odenbach1, Amanda Newton, Rebecca Gokiert
1Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada. odenbach@ualberta.ca.
Insights
Pediatric emergency departments need better tools to screen for post-traumatic stress disorder (PTSD) in children after physical injuries. This review evaluates existing screening tools for their accuracy and usefulness in identifying at-risk youth.
Area of Science:
- Pediatric Emergency Medicine
- Psychotraumatology
- Clinical Psychology
Background:
- Pediatric injuries are common, with emergency departments (EDs) primarily focusing on physical trauma.
- Children experiencing physical trauma are also at high risk for psychological trauma, including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD).
- Current ED guidelines lack effective screening for children at risk of developing stress disorders, leading to potential long-term consequences.
Purpose of the Study:
- To systematically review and evaluate screening tools for identifying or predicting PTSD in children following physical injury.
- To assess the psychometric properties, diagnostic accuracy, and clinical utility of these screening instruments.
- To determine the suitability of these tools for use in the pediatric ED setting.
Main Methods:
- A comprehensive search of multiple electronic databases (MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO) and other sources was conducted.
- Relevant articles were screened by title/abstract, with full-text retrieval and assessment by two independent reviewers.
- Data extracted included instrument characteristics, gold standard diagnostic properties, and quantitative diagnostic data (e.g., specificity, likelihood ratios), with quality assessed using QUADAS-2.
Main Results:
- The review aims to identify and describe available PTSD screening instruments for children.
- It will synthesize test-performance characteristics of these tools.
- Clinical utility, with a focus on ED suitability, will be described.
Conclusions:
- Effective screening tools are crucial for early identification of children at risk for stress disorders post-trauma.
- Implementing routine screening in pediatric EDs can improve early intervention.
- This review seeks to identify appropriate screening tools to enhance care for pediatric trauma patients.
Background:
Pediatric injury is highly prevalent and has significant impact both physically and emotionally. The majority of pediatric injuries are treated in emergency departments (EDs), where treatment of physical injuries is the main focus. In addition to physical trauma, children often experience significant psychological trauma, and the development of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) is common. The consequences of failing to recognize and treat children with ASD and PTSD are significant and extend into adulthood. Currently, screening guidelines to identify children at risk for developing these stress disorders are not evident in the pediatric emergency setting. The goal of this systematic review is to summarize evidence on the psychometric properties, diagnostic accuracy, and clinical utility of screening tools that identify or predict PTSD secondary to physical injury in children. Specific research objectives are to: (1) identify, describe, and critically evaluate instruments available to screen for PTSD in children; (2) review and synthesize the test-performance characteristics of these tools; and (3) describe the clinical utility of these tools with focus on ED suitability.
Methods:
Computerized databases including MEDLINE, EMBASE, CINAHL, ISI Web of Science and PsycINFO will be searched in addition to conference proceedings, textbooks, and contact with experts. Search terms will include MeSH headings (post-traumatic stress or acute stress), (pediatric or children) and diagnosis. All articles will be screened by title/abstract and articles identified as potentially relevant will be retrieved in full text and assessed by two independent reviewers. Quality assessment will be determined using the QUADAS-2 tool. Screening tool characteristics, including type of instrument, number of items, administration time and training administrators level, will be extracted as well as gold standard diagnostic reference properties and any quantitative diagnostic data (specificity, positive and negative likelihood/odds ratios) where appropriate.
Discussion:
Identifying screening tools to recognize children at risk of developing stress disorders following trauma is essential in guiding early treatment and minimizing long-term sequelae of childhood stress disorders. This review aims to identify such screening tools in efforts to improve routine stress disorder screening in the pediatric ED setting.
Trials Registration:
PROSPERO registration: CRD42013004893.
