Aggravating factors and assessment tools for Posttraumatic Stress Disorder in children after hospitalization

Posttraumatic stress disorder (PTSD) is a mental disorder caused by several distressing events that are related with psychotrauma. It is very frequent in childhood and untreated traumatic stress symptoms in children and adolescents often result in debilitating consequences on development with increased risks for a variety of physical and mental disorders. Ιt has been found that PTSD symptoms are reduced as soon as therapeutic interventions have been applied. The aim of the present review was to summarize the available literature regarding aggravating factors associated with the development of PTSD in children after hospitalization and assessment tools for a quick and reliable screening of children who are at risk for developing PTSD. A review of published papers was conducted until April 10, 2019 to identify articles that discuss the aggravating factors and the assessment tools for PTSD in children after hospitalization published in English, German or Greek language. Search was performed on PubMed with the following combination of key-words: "PTSD" and "children" and "hospitalization", using the filters ''human'' and "Publication date from 30/11/2007 to 09/04/2019" and choosing "all fields'' in PubMed Advanced Search Builder. Of the 115 articles reviewed, 16 relevant articles were included, 10 of them referred to the aggravating factors and the remaining 6 were related to the assessment tools. Significant aggravating factors associated with the development of PTSD were: traumatic injuries and illness/ medical-related hospital admission, previous health problems, Pediatric Intensive Care Unit (PICU) hospitalization, attendance at a hospital for child and adolescent psychiatry, female gender and psychotherapy and initial high Posttraumatic Stress Symptoms (PTSS) in parents. As for assessment tools, it was observed that the Child Trauma Screening Questionnaire (CTSQ)-Heart Rate (HR), the alternative PTSD algorithm (PTSD-AA), the Child Stress Disorders Checklist-Short Form (CSDC-SF), the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) model for PTSD symptom categories, the Posttraumatic Stress Disorder Semi-Structured Interview (PTSDSSI), the Preschool Children's Assessment of Stress Scale (PCASS) and the diagnostic interview for children and adolescents (DICA-P) led to the identification of children who were likely to develope or had already developed PTSD symptoms, in the study population wherein each was implemented. The greatest limitation - but also a significant finding - of this review is the scarceness of published studies on this topic. Overall, there is a variety of aggravating factors associated with the development of PTSD in children after hospitalization. Assessment tools should be able to identify immediately the children who are likely to or have already developed PTSD symptoms.