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Does Acute Propranolol Treatment Prevent Posttraumatic Stress Disorder, Anxiety, and Depression in Children with
Laura Rosenberg1,2, Marta Rosenberg1,2, Sherri Sharp1,2
11 Shriners Hospitals for Children-Galveston , Galveston, Texas.
Insights
Acute propranolol treatment did not significantly reduce posttraumatic stress disorder (PTSD), anxiety, or depression in pediatric burn patients. Long-term follow-up showed similar outcomes for children who received propranolol and those who did not.
Area of Science:
- Pediatric intensive care
- Trauma and burn recovery
- Psychopharmacology
Background:
- Pediatric intensive care unit (PICU) survivors, especially those with severe burns, are at high risk for developing posttraumatic stress disorder (PTSD), anxiety, and depression.
- Early interventions are crucial to mitigate long-term psychological sequelae in pediatric burn patients.
Purpose of the Study:
- To investigate the efficacy of acute propranolol administration in preventing PTSD, anxiety, and depression in children hospitalized in the PICU for large burns.
- To compare the long-term prevalence of PTSD, anxiety, and depression in children who received propranolol versus those who did not.
Main Methods:
- A long-term follow-up study of children previously enrolled in a randomized controlled trial comparing propranolol and nonpropranolol treatments.
- Assessment of lifetime PTSD, anxiety, and depression using validated child psychiatric interviews and inventories.
- Statistical analysis controlling for pain medication, anxiolytic, and antidepressant use.
Main Results:
- A total of 202 participants (89 propranolol, 113 controls) were assessed an average of 7 years postburn, with an average total body surface area burned of 56.4%.
- The prevalence of lifetime PTSD was 3.5% in the propranolol group and 7.2% in the control group, a difference that was not statistically significant.
- No significant differences were detected in the rates of PTSD, anxiety, or depression between the propranolol and control groups after accounting for other medications.
Conclusions:
- Acute propranolol treatment did not demonstrate a statistically significant preventive effect on the long-term development of PTSD, anxiety, or depression in pediatric burn patients.
- The standard of care, including timely pharmacotherapy for pain and anxiety and early psychotherapy, may have contributed to similar psychological outcomes in both groups.
- Further research may be needed to explore the role of propranolol or other interventions in specific subgroups of pediatric burn survivors.
Objective:
This study examined whether acute propranolol treatment prevented posttraumatic stress disorder (PTSD), anxiety, and depression in children hospitalized in the pediatric intensive care unit for large burns. We hypothesized that the prevalence of PTSD, anxiety, and depression would be significantly less in the propranolol than nonpropranolol groups.
Methods:
Children who had previously participated in a randomized controlled clinical trial of acute propranolol and nonpropranolol controls were invited to participate in long-term follow-up interviews. Eligible participants from 1997 to 2008 were identified from the electronic medical records, and data were collected in 2010-2011. Measures included the Missouri Assessment of Genetics Interview for Children to assess lifetime PTSD, Revised Children's Manifest Anxiety Scale to assess anxiety, and two depression inventories Children's Depression Inventory and Beck Depression Inventory-II.
Results:
Of 202 participants, 89 were in the propranolol group and 113 were nonpropranolol controls. Children were an average of 7 years postburn. The average total body surface area burned was 56.4 + 15.1% (range = 24%-99%). The mean dose of propranolol was 3.64 ± 3.19 mg/kg per day (range = 0.36-12.12). The duration of propranolol inpatient treatment days varied, mean days 26.5 ± 19.8. The prevalence of lifetime PTSD in the propranolol group was 3.5% and controls 7.2%, but this difference was not statistically significant. We controlled for administration of pain medications, anxiolytics, and antidepressants overall and no significant differences were detected in the rates of PTSD, anxiety, or depression.
Conclusions:
The prevalence of PTSD, anxiety, and depression was similar in children who received propranolol acutely and those who did not. This may be influenced by the standard of care that all children received timely pharmacotherapy for pain and anxiety management and psychotherapy beginning in their acute phase of treatment.
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