超越身体损伤：儿科创伤患者急性应激障碍和创伤后应激障碍的常规筛查——一项纵向队列试点研究。
Beyond Physical Injury: Routine Screening for Acute Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients - A Longitudinal Cohort Pilot Study.
作者信息
Liang Norah E, Alvarez Katherine, Dalusag Kyla, Chan Katy, Bunnell Brittney, Stroud Melanie, Steele Kathleen, Chao Stephanie D
机构信息
Department of Surgery, Stanford University, Stanford, CA, USA.
Department of Surgery, Stanford University, Stanford, CA, USA.
出版信息
J Pediatr Surg. 2025 Feb;60(2):161982. doi: 10.1016/j.jpedsurg.2024.161982. Epub 2024 Oct 3.
INTRODUCTION
Early identification of children at risk for PTSD is critical for improving mental health outcomes after traumatic injury. Currently, there is no standard PTSD screen for pediatric trauma patients and limited data on long-term quality of life for those who screen positive.
METHODS
In 2022, we piloted a comprehensive routine screening program for ASD and PTSD at our Level I PTC. All admitted trauma patients ≥8 years old were eligible for screening. Inpatients were administered the ASC3. Those who screened positive were referred for follow-up and repeat mental health evaluation. PTSD screening (CTSQ, CPSS) and quality-of-life screening (PedsQL™) surveys were administered to eligible discharged trauma patients at 1-month post-injury. Children who screened positive on the CTSQ or CPSS were referred for behavioral health services.
RESULTS
205 children were screened for ASD using the ASC3. 49/205 children (23.9 %) had a positive screen (score ≥3). 56 children completed PTSD screening at 1-month post-discharge. 14/54 children (25.9 %) screened positive on CTSQ, and 8/50 children (16 %) screened positive on CPSS. There was a significant positive correlation between CTSQ and CPSS scores (r 0.76, ∗P<0.0001). When stratified by screening results, patients who screened positive on CTSQ and CPSS were found to have the most significant correlations with poor School and Emotional Functioning on their quality-of-life inventory.
CONCLUSION
Early screening for ASD may be predictive of later development of PTSD in children. Screening using previously validated tools (ASC3, CTSQ, CPSS) were effective in identifying children with negative emotional functioning lasting beyond the acute phase of physical recovery following injury. CTSQ and CPSS both performed well for screening at one-month post-discharge. Early identification can facilitate timely referral to mental health services to potentially minimize long-term socioemotional impact of PTSD.
引言
早期识别有创伤后应激障碍（PTSD）风险的儿童对于改善创伤性损伤后的心理健康结局至关重要。目前，尚无针对儿科创伤患者的标准PTSD筛查方法，且对于筛查呈阳性者的长期生活质量数据有限。
方法
2022年，我们在一级儿科创伤中心对自闭症谱系障碍（ASD）和PTSD开展了一项全面的常规筛查项目。所有8岁及以上的入院创伤患者均符合筛查条件。住院患者接受了《自闭症筛查问卷第三版》（ASC3）评估。筛查呈阳性者被转介进行随访及重复心理健康评估。在受伤后1个月，对符合条件的出院创伤患者进行PTSD筛查（儿童创伤后应激障碍筛查量表[CTSQ]、儿童PTSD症状量表简版[CPSS]）和生活质量筛查（儿童生活质量量表[PedsQL™]）调查。CTSQ或CPSS筛查呈阳性的儿童被转介接受行为健康服务。
结果
使用ASC3对205名儿童进行了ASD筛查。49/205名儿童（23.9%）筛查呈阳性（得分≥3）。56名儿童在出院后1个月完成了PTSD筛查。14/54名儿童（25.9%）CTSQ筛查呈阳性，8/50名儿童（16%）CPSS筛查呈阳性。CTSQ和CPSS得分之间存在显著正相关（r = 0.76，*P<0.0001）。按筛查结果分层时，发现CTSQ和CPSS筛查呈阳性的患者在其生活质量量表上与学校和情绪功能差的相关性最为显著。
结论
ASD的早期筛查可能预示儿童后期PTSD的发生。使用先前验证过的工具（ASC3、CTSQ、CPSS）进行筛查有效地识别了受伤后身体恢复急性期后仍持续存在负面情绪功能的儿童。CTSQ和CPSS在出院后1个月的筛查中表现均良好。早期识别有助于及时转介至心理健康服务机构，从而有可能将PTSD的长期社会情感影响降至最低。
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