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The Relationship Between Demographic and Medical Characteristics and the Development of Posttraumatic Stress Disorder
Anna McKinnon1, Zoe Mermin2, Tim Dalgleish3
1McKinnon Psychology, Edgecliff, New South Wales, Australia.
Insights
Children exposed to trauma may develop posttraumatic stress disorder (PTSD). Interpersonal violence significantly increases PTSD risk in pediatric emergency department patients, though other factors also contribute.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Psychology
- Child Psychiatry
Background:
- Posttraumatic stress disorder (PTSD) is a potential complication for children experiencing traumatic events.
- Predicting PTSD development in pediatric populations after emergency department (ED) visits requires understanding risk factors.
Purpose of the Study:
- To evaluate demographic and medical data from ED visits for predicting PTSD in children.
- To identify predictors of PTSD development 2 months after ED attendance for trauma exposure.
Main Methods:
- Prospective longitudinal study of 231 children (8-17 years) across 4 East of England EDs (2010-2013).
- Data collected within 2 weeks of ED attendance; PTSD assessed via structured interview at 2 months.
- Univariate and logistic regression analyses used to identify PTSD predictors.
Main Results:
- 10% of children met PTSD criteria at 2 months post-ED visit.
- Variables distinguishing PTSD and non-PTSD groups included systolic blood pressure, pulse, injury count, interpersonal violence, and head injury.
- Assault was a significant predictor of PTSD (OR=5.07), but models had poor sensitivity (0.30).
Conclusions:
- PTSD affects a notable minority of children exposed to death or serious injury.
- Children who are victims of interpersonal violence face a higher risk of developing PTSD.
Objectives:
This study adopted a prospective longitudinal design to assess the utility of demographic and medical characteristics routinely available to emergency medicine clinicians to predict the development of posttraumatic stress disorder (PTSD) in children exposed to death or serious injury 2 months following emergency department (ED) attendance.
Methods:
A sample of children (8-17 years; N = 231) were recruited from 4 EDs in the East of England between 2010 and 2013. Within 2 weeks of attendance, research nurses screened records for appropriate cases and recorded information on relevant variables from ED attendance notes. At 2 months, a research assistant carried out a structured clinical interview to assess their Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD symptoms. Univariate analyses were conducted to compare ED characteristics between children who developed PTSD and those who did not. Logistic regression models were used to identify variables associated with increased risk of PTSD.
Results:
Ten percent of children met the criteria for PTSD at 2 months. Systolic blood pressure, pulse, number of injuries, being subjected to interpersonal violence, and having a head injury were variables that distinguished PTSD and non-PTSD groups. Logistic regression models showed that being assaulted was predictive of PTSD (Odds ratio = 5.07, 95% CI [1.51, 17.00]); although these models had excellent specificity (0.96), the sensitivity was poor (0.30)-that is, there were a number of cases who developed PTSD but were not assaulted.
Conclusion:
PTSD is a complication of exposure to death or injury that occurs in a significant minority of children. Children who are victims of interpersonal violence are more likely to develop the disorder.
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