The Incidence of Posttraumatic Stress Symptoms in Children

OBJECTIVE: To determine the incidence of posttraumatic stress disorder (PTSD) symptoms and risk factors for their development in children and adolescents undergoing orthopaedic surgery for trauma. DESIGN: Prospective cohort study. SETTING: Level-1 trauma center. PATIENTS: Children (8 to 18), undergoing surgery for orthopaedic trauma. INTERVENTION: Upper and lower extremity surgery for orthopaedic trauma. MAIN OUTCOME MEASUREMENTS: PTSD symptoms at postoperative follow-up as determined by the Child PTSD Symptom Scale (CPSS). RESULTS: A total of 176 children with an average age at surgery of 13 years (8 to 18.8 years) participated in the study. Twenty-six subjects had high levels of PTSD symptoms (15%; 95% CI = 10.0 to 21.1%). Univariable and multivariable analyses determined that female sex (OR 2.63, 95% CI = 1.06 to 6.67, P = 0.04), older age at surgery (OR 1.25, 95% CI = 1.04 to 1.51, P = 0.02), and undergoing a previous surgery (OR 2.86, 95% CI = 1.06 to 7.73, P = 0.04) were all associated with increased PTSD risk. CONCLUSIONS: Children and adolescents experience a high level of PTSD symptoms (15%) after surgery for orthopaedic trauma. Clinicians should be aware of PTSD symptoms in children and adolescents after surgery for orthopaedic injuries and use comprehensive screening to facilitate timely intervention and treatment. LEVEL OF EVIDENCE: II.