Stoddard Frederick J, Sorrentino Erica, Drake Jennifer E, Murphy J Michael, Kim Abigail J, Romo Stephanie, Kagan Jerome, Snidman Nancy, Saxe Glenn, Sheridan Robert L
From the *Shriners Hospital for Children - Boston, Massachusetts; †Massachusetts General Hospital and Harvard Medical School, Boston; ‡Massachusetts General Hospital, Boston; §Harvard Medical School, Boston; and ‖NYU Langone Medical Center, New York, New York.
J Burn Care Res. 2017 Jan/Feb;38(1):e343-e351. doi: 10.1097/BCR.0000000000000386.
The primary aim of this study was to assess the prevalence of posttraumatic stress disorder (PTSD) in young children hospitalized for burns. A secondary aim was to assess partial PTSD in this population. PTSD diagnosis and symptoms were evaluated utilizing both the diagnostic interview for children and adolescents (DICA-P) module and the PTSD semistructured interview and observational report (PTSDSSI). PTSD symptomatology was assessed from parent interviews at 1 month after discharge from a major pediatric burn center. Four of the 42 participants who completed the DICA-P met full criteria for a diagnosis of PTSD (10%).Of the 39 who also completed the PTSDSSI, 1 (3%) met full criteria for PTSD diagnosis on that measure. Twenty-seven percentage of subjects met partial criteria on the DICA-P vs 16% on the PTSDSSI, without impairment. Furthermore, 67% of subjects met DICA-P criteria for the re-experiencing cluster and 54% met the PTSDSSI re-experiencing criteria. Although only a small percentage met full PTSD diagnostic criteria by either measure, a high percentage of young children with burns manifested some posttraumatic symptoms 1 month after discharge. Because PTSDSSI diagnosis is strongly linked to the diagnostic and statistical manual-5 (DSM-5) criteria for "PTSD in children 6 years and younger," these results may offer clues to current diagnoses of PTSD in young children. Future research is needed to improve care by determining the risk factors and course of PTSD to further refine the diagnostic criteria for identifying children most in need of intervention, such as those hospitalized for burn injuries.
本研究的主要目的是评估因烧伤住院的幼儿创伤后应激障碍(PTSD)的患病率。次要目的是评估该人群中的部分PTSD。使用儿童和青少年诊断访谈(DICA-P)模块以及PTSD半结构化访谈和观察报告(PTSDSSI)对PTSD诊断和症状进行评估。在一家大型儿科烧伤中心出院1个月后,通过对家长的访谈来评估PTSD症状。完成DICA-P的42名参与者中有4名(10%)符合PTSD诊断的全部标准。在39名同时完成PTSDSSI的参与者中,有1名(3%)在该测量中符合PTSD诊断的全部标准。27%的受试者在DICA-P上符合部分标准,而在PTSDSSI上为16%,且未出现功能损害。此外,67%的受试者符合DICA-P中再体验集群的标准,54%符合PTSDSSI再体验标准。尽管通过任何一种测量方法只有一小部分符合PTSD的全部诊断标准,但很大比例的烧伤幼儿在出院1个月后表现出一些创伤后症状。由于PTSDSSI诊断与《精神疾病诊断与统计手册》第5版(DSM-5)中“6岁及以下儿童PTSD”的标准密切相关,这些结果可能为当前幼儿PTSD的诊断提供线索。未来需要通过确定PTSD的风险因素和病程来改善护理,以进一步完善诊断标准,从而识别出最需要干预的儿童,例如因烧伤住院的儿童。