Acute Stress Screening After Discharge of Injured Children: A Quality Improvement Initiative
*Katie Downie, Valerie Amador, *Mubeen Jafri
Randall Children's Hospital, Portland, OR
Background (issue): Early identification of symptoms of Acute Stress Disorder in injured children is essential for improved patient outcomes. Screening for acute stress after injury and hospitalization may lead to earlier intervention and prevention of Post-Traumatic Stress Disorder (PTSD).
Methods: A retrospective review was conducted of all children discharged from a Level 1 Pediatric Trauma center ages 5- 17 years from March 2020 - March 2022. During this time, the Child Stress Disorders Checklist- Short Form (CSDC-SF) screening tool was administered by a preadmission and discharge service (PADS) team by telephone to the caregivers of injured children within 3 days of discharge. The validated screening tool utilizes four questions scored from 0-2 resulting in a final score of 0-8. If any patient scored greater than zero, primary care follow-up was recommended.
Findings: 233 children met the criteria for a trauma admission post-discharge phone call by the PADS team. 174 of those patients had attempted contact after discharge (75%) and 111 successfully completed the CSDC-SF screening questions (64%). During these two years, 6 cases (5%) had a score greater than zero, which indicates identification of one or more acute stress symptoms. Those 6 cases had PCP appointments recommended by the PADS team or were confirmed as already scheduled, 4/6 having available documentation confirming follow up occurred. Missed screens occurred in patients discharged to rehabilitation, patients who died, children who suffered abuse and had alternate screens, and patients who were screened by their PCP or another specialty.
Conclusions (implications for practice): The CSDC-SF is a validated acute stress screening tool for children and adolescents and is particularly useful in settings with time constraints and where self-reporting is not possible or reliable. We demonstrate that this tool can be effectively used with post-discharge phones calls to identify patients that may benefit from intervention.
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