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Published online May 2, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1261-1267 (doi:10.1542/peds.2004-1217)
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Posttraumatic Stress Responses in Children: Awareness and Practice Among a Sample of Pediatric Emergency Care Providers

Michael F. Ziegler, MD, Michael H. Greenwald, MD, Michael A. DeGuzman, MPH, Harold K. Simon, MD

From the Departments of Pediatrics and Emergency Medicine, Division of Pediatric Emergency Medicine, Emory University School of Medicine/Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia

Background. Research suggests that up to 4 of 5 children experience symptoms of an acute stress response (ASR) after a motor vehicle–related injury, and ~25% will develop posttraumatic stress disorder (PTSD). The degree to which physicians recognize this problem has not been reported. Our objective was to evaluate current awareness and practices of a cohort of pediatric emergency care providers regarding posttraumatic stress in children.

Methods. Participants were identified from a list of the American Academy of Pediatrics Section on Emergency Medicine and surveyed on their awareness of ASR after motor vehicle–related injury, risk factors for developing PTSD, and practices regarding emergency department (ED) interventions. Surveys from physicians not practicing clinical emergency medicine were excluded.

Results. Of 322 surveys returned, 287 responses met inclusion criteria. Among these respondents, 198 (69%) were pediatric emergency medicine board certified or eligible and 260 (91%) practiced in a designated pediatric ED. Only 20 of 287 respondents (7%) believed that children were likely to develop symptoms of posttraumatic stress at levels previously described. Also in contrast to recent literature, 248 respondents (86%) felt that severity of injury was associated with future development of PTSD. Associated parental injury was identified accurately as a risk factor by 250 respondents (87%). Of interest, only 31 respondents (11%) were aware of any available tools to assess risk for PTSD. In addition, 56 of 287 respondents (20%) indicated that they would not use such tools in the ED, most commonly citing time and cost constraints. Finally, only 52 respondents (18%) reported giving any verbal guidance and only 9 (3%) provided any written instructions about posttraumatic stress to their patients and families.

Conclusions. Findings suggest that physicians underestimate the likely development of an ASR and PTSD in the pediatric population. At present, few physicians offer written or even verbal instruction related to the development of posttraumatic symptoms. Physician education along with a systematic approach of assessment and intervention is necessary to address the gap between underrecognition of this concern and desired clinical practice.

Key Words: anticipatory guidance • child behavior • posttraumatic stress disorder • trauma

Abbreviations: PTSD, posttraumatic stress disorder • ASD, acute stress disorder • ASR, acute stress response • ED, emergency department • STEPP, Screening Tool for Early Predictors of PTSD • AAP, American Academy of Pediatrics • CI, confidence interval • OR, odds ratio

Accepted Sep 28, 2004.


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