儿科创伤患者急性创伤后应激障碍和创伤后应激障碍的筛查：一项初步研究。
Screening of Acute Traumatic Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients: A Pilot Study.
机构信息
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Atrium Health Carolinas Medical Center, Charlotte, North Carolina (Drs Mazo and Reynolds); Hemby Pediatric Trauma (Ms Waddell) and The F. H. "Sammy" Ross Jr. Trauma Center (Ms Raddatz and Dr Christmas), Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina; Dayton Children's Hospital, Dayton, Ohio (Dr Blankenship); Department of Psychiatry, Atrium Health Behavioral Health-Charlotte, Charlotte, North Carolina (Dr Rachal); and Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Atrium Health Levine Children's Hospital, Charlotte, North Carolina (Dr Reynolds). Dr Mazo is now at the Division of Pediatric Emergency Medicine, Children's Hospital Colorado-Colorado Springs.
出版信息
J Trauma Nurs. 2021;28(4):235-242. doi: 10.1097/JTN.0000000000000591.
BACKGROUND
Children who experience traumatic physical injuries are at risk of developing acute stress disorder and posttraumatic stress disorder (PTSD). Early identification and treatment of these high-risk children can lead to improved mental health outcomes in this population.
OBJECTIVE
This study assesses the feasibility of a study protocol that compares 3 screening tools for identifying patients at a high risk of later development of acute stress disorder or PTSD among pediatric trauma patients.
METHODS
This pilot study compared 3 questionnaires used as screening tools for predictors of later development of PTSD in a convenience sample of pediatric trauma patients aged 7-17 years. Patients were randomized to one of 3 screening tools. Families were contacted at 30, 60, and 90-120 days postinjury to complete the Child Report of Post-Traumatic Symptoms questionnaire. The sensitivity and negative predictive value of the screening tools were compared for the diagnosis of PTSD defined using the Child Report of Post-Traumatic Symptoms questionnaire.
RESULTS
Of the 263 patients identified for possible enrollment, 52 patients met full inclusion criteria and agreed to participate. Only 29 (55.7%) patients completed at least one follow-up questionnaire. The prevalence of acute stress disorder and PTSD in our population was 41% (95% CI [24, 61]) and 31% (95% CI [15, 51]), respectively.
CONCLUSIONS
In this pilot study, we sought to determine the utility of the 3 commonly used screening instruments for measuring traumatic stress symptoms in pediatric trauma patients to predict the diagnosis of acute stress disorder or PTSD. Limitations include the use of the Child Report of Post-Traumatic Symptoms screening tool as the gold standard for calculating test characteristics and lack of 24/7 enrollment capabilities. As such, a significant portion of patients were discharged prior to our teams' engagement for enrollment.
背景
经历创伤性身体损伤的儿童有患急性应激障碍和创伤后应激障碍（PTSD）的风险。早期识别和治疗这些高风险儿童可以改善该人群的心理健康结局。
目的
本研究评估了一项研究方案的可行性，该方案比较了 3 种筛选工具，用于识别儿科创伤患者中以后发生急性应激障碍或 PTSD 的高危患者。
方法
本试点研究比较了 3 种用于识别 7-17 岁儿科创伤患者以后发生 PTSD 的预测因素的问卷作为筛查工具。患者被随机分配到 3 种筛查工具中的一种。在受伤后 30、60 和 90-120 天，家属联系以完成儿童创伤后症状报告问卷。比较了筛查工具对使用儿童创伤后症状报告问卷定义的 PTSD 诊断的敏感性和阴性预测值。
结果
在确定可能入组的 263 名患者中，有 52 名患者符合全部纳入标准并同意参加。只有 29 名（55.7%）患者完成了至少一次随访问卷。在我们的人群中，急性应激障碍和 PTSD 的患病率分别为 41%（95%CI[24,61]）和 31%（95%CI[15,51]）。
结论
在本试点研究中，我们试图确定 3 种常用的筛查工具在测量儿科创伤患者创伤后应激症状以预测急性应激障碍或 PTSD 诊断中的效用。局限性包括使用儿童创伤后症状报告筛查工具作为计算测试特征的金标准，以及缺乏 24/7 入组能力。因此，在我们的团队参与入组之前，相当一部分患者已经出院。
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