Pediatric Trauma Society

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Missed Diagnoses of Post-Traumatic Stress Disorder, after Hospitalized Injury, May Manifest as Other Psychiatric Issues
Melanie B. LaPlant, MPH; Bradley J. Segura, MD, PhD; Robert D. Acton, MD; Daniel A. Saltzman, MD, PhD; Donavon J. Hess, MD, PhD, MBA
University of Minnesota, Minneapolis, MN

Background: Post-traumatic stress disorder (PTSD) occurs in up to 19% of injured pediatric patients. Injured pediatric patients are rarely routinely screened for PTSD. We hypothesized that the rate PTSD diagnosis is lower than 19% without screening, but other "surrogate" psychiatric factors may manifest.

Methods: We reviewed medical records from a large health system, from 2005 through 2015, for all pediatric (ages 6-18) patients who had an injury diagnosis during an inpatient or emergency department visit (n = 17,346); children seen at well-child visits served as the comparison "non-injured" group (n = 52,963). We searched for an initial acute stress disorder (ASD) or PTSD diagnosis, and for other mental health diagnoses. We compared groups using a chi-square test and calculated adjusted rate ratios with Poisson regression offset by follow-up time.

Results: The diagnosis rate for injured children was 0.02% ASD and 0.18% PTSD (Table). The adjusted rate of PTSD diagnosis was 177% higher among injury patients compared to control patients (ARR, 2.77; 95% CI, 1.63 4.70). Potential surrogate diagnoses manifested at a higher rate among injured children (5.92% vs 4.91%, p< 0.01).

Conclusions: Injured children are underdiagnosed for PTSD in the absence of screening programs. Other psychiatric diagnoses may manifest as surrogate indicators of PTSD. Universal screening of injured children patients may be necessary to identify PTSD so that patients may receive mental health services.

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