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Persistence of Posttraumatic Stress in Violently Injured Youth Seen in the Emergency Department
Joel A. Fein, MD;
Nancy Kassam-Adams, PhD;
Maureen Gavin, MPH;
Rex Huang, BA;
Deena Blanchard, MPH;
Elizabeth M. Datner, MD
Arch Pediatr Adolesc Med. 2002;156:836-840.
Objective To determine if symptoms of posttraumatic stress, initially evaluated
in the emergency department (ED) setting, persist over time.
Design Prospective cohort study.
Setting Two urban, academic medical center EDs.
Patients Sixty-nine injured patients, aged 12 to 24 years, were assessed for
acute posttraumatic stress symptoms at the time of their enrollment in an
ongoing ED-based study of intentional youth violence, and assessed for posttraumatic
stress symptoms up to 5 months later.
Main Outcome Measures The Immediate Stress Reaction Checklist, administered during the ED
visit, and the Symptom Checklist of the Child and Adolescent Trauma Survey,
administered during routine telephone follow-up.
Results Patients in the emergency department reported a range of acute stress
symptoms on the Immediate Stress Reaction Checklist, with 25% reporting clinically
significant distress. On follow-up assessment, 15% reported significant posttraumatic
stress symptoms. The severity of acute stress symptoms was strongly associated
with the severity of posttraumatic stress symptoms at follow-up (r = 0.55, P<.005). Age, sex, injury type,
and time from injury to follow-up were not associated with the degree of acute
stress or posttraumatic stress symptom severity at initial or follow-up assessment.
Conclusion This study provides preliminary evidence that acute stress symptoms,
assessed in the ED in the immediate aftermath of a traumatic injury, are useful
indicators of risk for later posttraumatic stress.
From the Divisions of Emergency Medicine (Dr Fein, Mss Gavin and Blanchard,
and Mr Huang) and General Pediatrics (Dr Kassam-Adams), the Children's Hospital
of Philadelphia, Emergency Department (Dr Datner), the Hospital of the University
of Pennsylvania, and Departments of Pediatrics (Dr Fein, Mss Gavin and Blanchard,
and Mr Huang), Child and Adolescent Psychiatry (Dr Kassam-Adams), and Emergency
Medicine (Dr Datner), the University of Pennsylvania School of Medicine, Philadelphia.
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