Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #67, 10:00 am OTA-2011
A Prospective Evaluation of Posttraumatic Stress Disorder and Parent Stress in Children Exposed to Orthopaedic Trauma
Meagan Wallace, MD; Aki Puryear, MD; Lisa K. Cannada, MD;
Saint Louis University, Dept. of Orthopaedic Surgery, St. Louis, Missouri, USA
Purpose: Trauma has more than just physical effects on pediatric patients and their families. The purpose of this study was to evaluate pediatric orthopaedic trauma patients, and pediatric patients with isolated nonoperative upper extremity fractures along with their parents for emotional/psychological symptoms associated with posttraumatic stress disorder (PTSD). We hypothesized pediatric orthopaedic trauma patients with high-energy injuries would have significant rates of PTSD compared to the patients with isolated low-energy upper extremity fractures.
Methods: An IRB-approved prospective study was conducted of pediatric patients 8 to 18 years of age who sustained a traumatic injury or an isolated upper extremity fracture at least 3 months prior to being seen in clinic. Data were collected from October 2009 to May 2010. Exclusion criteria included a traumatic brain injury with Glascow Coma Score <15. Demographic data, injury details, and information on the child’s school and extracurricular activities were obtained. The Child PTSD Symptom Scale (CPSS) was utilized to evaluate the patients for PTSD. The Parent Stress Index (PSI) was utilized to evaluate the stress of the parents/guardian. For 80% power, we needed to recruit 32 children per group. P value was set at <0.05.
Results: A total of 76 children and their parent/guardian participated in the study. The mean age was 12.6 years (range, 8-17 years). There were 56 males (74%) and 20 females (26%). The average time since injury was 12 months (range, 3-89 months). 32 children in the trauma group had surgery, with 10 having more than 1 surgery. No patients in the isolated upper extremity group had surgery. The data were evaluated based on 4 groups: trauma patients with PTSD, trauma patients without PTSD, upper extremity patients with PTSD, and upper extremity patients without PTSD. Overall 33% of our total patients had PTSD: 24% of the trauma group and 9% of the upper extremity group. We found pediatric patients who experience high- or low-energy trauma can have PTSD. Involvement in music was found to be protective against PTSD (P = 0.037). In our population, the stress of the parent was not associated with PTSD in the child.
Conclusion: PTSD commonly affects pediatric patients who sustain injuries as a result of a traumatic event, whether low- or high-energy mechanisms. We found no factors significantly associated with or predictive of PTSD in our 4 patient groups. Awareness of PTSD is important and we need to have a high index of suspicion in all pediatric trauma patients regardless of the energy associated with the traumatic event. Patients who exhibit signs of PTSD should be provided with resources so that an intervention can be done in a timely manner.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.