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Making Trauma Less Traumatic: Implementing Inpatient Pediatric Screening of Acute Stress Symptoms.

Jennifer Fuchs1, Eric Zwemer1, Amanda Gillespie2

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Pediatric trauma centers now screen admitted patients for acute stress disorder. A new consultation service increased screening rates to 100%, identifying significant psychological distress, though follow-up remains a challenge.

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Area of Science:

  • Pediatric Trauma Care
  • Psychological Sequelae of Injury
  • Quality Improvement in Healthcare

Background:

  • Pediatric patients hospitalized for physical injury and trauma face heightened risks of acute stress disorder.
  • The American College of Surgeons mandated routine identification and treatment referral for psychological sequelae in pediatric trauma centers in 2022.
  • Effective screening and intervention models are crucial for addressing the psychological impact of trauma in children.

Purpose of the Study:

  • To implement and evaluate a quality improvement initiative aimed at increasing psychological screening consults for admitted pediatric trauma patients.
  • To achieve an 80% screening rate for eligible pediatric trauma patients within a 6-month period.
  • To establish a dedicated consultation service for screening, treatment, and referral of psychological symptoms.

Main Methods:

  • A quality improvement intervention was designed to enhance the identification of posttraumatic psychological symptoms.
  • A dedicated 'Making Trauma Less Traumatic' consultation service with a therapist was established.
  • Key interventions included stakeholder education and iterative improvements to the consultation workflow, with screening consult frequency as the primary measure.

Main Results:

  • Psychological screening consults for eligible pediatric trauma patients increased from a baseline of 4.1% to a weekly mean of 100% between September 2020 and November 2021.
  • 32.7% of screened patients exhibited at least one symptom of acute stress.
  • While no families declined screening or therapy, 29.5% were lost to intended follow-up.

Conclusions:

  • A successful model for routine psychological screening of pediatric trauma patients was implemented using a dedicated consultation service.
  • A significant proportion of admitted pediatric trauma patients screened positive for psychological symptoms during hospitalization.
  • The intervention demonstrated family acceptance, but challenges persist in ensuring consistent follow-up care.