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An Evaluation of Posttraumatic Stress Disorder and Parent Stress in Children With Orthopaedic Injuries

Wallace, Maegen MD; Puryear, Aki MD; Cannada, Lisa K. MD

doi: 10.1097/BOT.0b013e318250c837
Original Article

Objectives: Trauma has more than physical effects on pediatric patients and their families. The purpose of this study was to evaluate pediatric orthopaedic trauma patients and patients with isolated nonoperative upper extremity (UE) fractures for emotional/psychologic symptoms associated with posttraumatic stress disorder (PTSD) and parent stress.

Methods: An institutional review board–approved prospective study of patients aged 8–18 years who sustained a traumatic injury or isolated UE fracture from October 2009 to May 2010 was performed. Demographic data were obtained and the Child PTSD Symptom Scale was used. The Parent Stress Index was used to evaluate the stress of the parents/guardian. For 80% power, we needed 32 per group. P value was set at <0.05.

Results: A total of 76 children and their parents/guardians participated in the study. The mean age was 12.6 years (8–17 years). There were 56 males (74%) and 20 females (26%). The average time since injury was 12 months (3–89 months). The prevalence of PTSD between the high-energy trauma patients and the low-energy nonoperative UE patients was not significant. Overall, 33% of the children had PTSD. Involvement in music was significant between patients with and without PTSD (P = 0.037) and may be protective against PTSD.

Conclusions: PTSD commonly affects pediatric patients who sustain injuries as a result of a traumatic event, whether low- or high-energy mechanisms. We found no factors significantly associated with or predictive of PTSD and did not find an association of PTSD with parent stress. We need to maintain a high index of suspicion in pediatric trauma patients regardless of the energy associated with the traumatic event.

Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Department of Orthopaedic Surgery, Saint Louis University, St Louis, MO.

Reprints: Lisa K. Cannada, MD, Department of Orthopaedic Surgery, Saint Louis University, 3536 Vista Avenue, 7th Floor Desloge Tower, St Louis, MO 63110 (e-mail:

Presented in part at the Pediatric Science Day Cardinal Glennon Children's Hospital, February 2011; Orthopaedic Research and Education Foundation and the Orthopaedic Research Society Midwest Heartland Resident Research Symposium, March 2011; and The Orthopaedic Trauma Association Annual Meeting, San Antonio, Texas, October, 2011.

The authors report no conflict of interest.

Accepted February 16, 2012

© 2013 Lippincott Williams & Wilkins, Inc.