Published online January 4, 2006
PEDIATRICS Vol. 117 No. 1 January 2006, pp. 130-138 (doi:10.1542/peds.2005-1042)
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Primary Care Utilization and Detection of Emotional Distress After Adolescent Traumatic Injury: Identifying an Unmet Need

Janice A. Sabin, MSW, PhCa,b, Douglas F. Zatzick, MDb,c,d, Gregory Jurkovich, MDb,d,e and Frederick P. Rivara, MD, MPHb,d,f

a School of Social Work
b Harborview Injury Prevention and Research Center
c Departments of Psychiatry and Behavioral Sciences
e Surgery
f Pediatrics, University of Washington, Seattle Washington
d Harborview Medical Center, Seattle, Washington

OBJECTIVE. Few investigations have assessed the primary care detection of adolescent posttraumatic emotional distress after an injury. We aimed to determine (1) the level of attachment to primary care providers (PCPs) and school providers among this group of high-risk adolescents, (2) the emotional status of this population postinjury, (3) continuity of care between trauma center and community care, and (4) PCPs' detection of emotional problems in adolescents after an injury.

METHODS. This was a prospective cohort study of traumatically injured adolescents aged 12 to 18 who were admitted to a level I regional trauma center. Adolescents were screened for posttraumatic stress symptoms, depressive symptoms, and alcohol use on the surgical ward and 4 to 6 months postinjury. PCPs were contacted by telephone 4 to 6 months postinjury to assess follow-up care and the detection of emotional distress.

RESULTS. In the surgical ward, 39.4% of the adolescent patients or their parents reported no identifiable source of regular medical care. Only 24.3% of the patients had visited a PCP during the 4 to 6 months after injury. At 4 to 6 months postinjury, 30% of the adolescents were experiencing high posttraumatic stress symptom levels, 11% were experiencing high depressive symptom levels, and 17% had high levels of alcohol use. PCPs did not detect any new emotional distress or problem drinking during postinjury office visits.

CONCLUSIONS. Injured adolescents represent a high-risk pediatric population, a substantial number of whom develop mental health problems postinjury. Furthermore, almost 40% of adolescents in our study reported no source of primary care. These results suggest that referrals from trauma centers to PCPs are necessary and that an increase in awareness of and screening for adolescent emotional distress postinjury during follow-up appointments and at school should be routine components of postinjury care.

Key Words: adolescents • injury • primary care utilization • detection • posttraumatic stress • alcohol use • depression

Abbreviations: PTS—posttraumatic stress • DSM-IV—Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • PTSD—posttraumatic stress disorder • PCP—primary care provider • RI—University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index • ISS—injury severity score • OR—odds ratio • CI—confidence intervals

Accepted Jun 27, 2005.




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