A new screen may allow physicians to estimate risk for child or parent posttraumatic stress disorder following a child’s injury, according to an article in the August 6th issue of the Journal of the American Medical Association. The authors hope that use of the screening tool will improve diagnosis and treatment of a disorder that is currently common but underdiagnosed.

“Until now, health care providers did not have a simple way to tell, early on, who could be at risk of posttraumatic stress disorder after a child injury,” said Flaura K. Winston, M.D., Ph.D., lead author of the study. “We hope that acute care physicians can use this screening tool to help determine who should be referred for psychological evaluation and intervention.”

Through their ongoing research, Winston and her American colleagues found that severity of injury is not necessarily a predictor. Instead, a combination of event-related factors, early physiological reactions such as heart rate, and early psychological responses serve to predict future development of the disorder.

The screening tool was developed in a population of children who had traffic-related injuries and their parents. A total of 171 families completed a 50-question risk factor survey at the initial treatment and at a 3-month follow-up assessment. Questions in the final tool were derived from the combination of responses that most often predicted persistent posttraumatic stress at 3 months follow-up. For example, useful questions for children asked if they were separated from their parents or had been very afraid. Parent questions asked about feelings of helplessness and whether they had witnessed the child’s injury. The final tool includes 4 yes/no questions asked of the parent, 4 yes/no questions asked of the child, and 4 items easily obtained from medical records.

Of children who screened positive, 25 percent were eventually diagnosed with posttraumatic stress disorder in sharp contrast to children who screened negative, only 5 percent of whom developed the disorder. Of parents who screened positive, 27 percent developed the disorder compared with only 1 percent of parents who screened negative.

The researchers hope that use of the screening tool at the time of injury will identify people at risk for the disorder, allowing at-risk family members and their primary-care physicians to watch for symptoms of the disorder and make early referrals for psychiatric evaluation and treatment, if needed.