Prospective study of post-traumatic stress disorder in children involved in road traffic accidents

British Medical Journal, Dec 12, 1998 by Paul Stallard, Richard Velleman, Sarah Baldwin

Identification of children

The subjects were identified each week from the records in the department. Standard information was collected, including basic demographic details, whether the child was admitted, a proxy measure of severity of injury determined by the Manchester triage priority scale,[17] number of x rays pictures taken, and whether any fractures or blows to the head were identified. The Manchester triage scale is a standardised 5 point priority system designed to ensure that patients are seen in order of clinical need rather than attendance. A rating of 1 indicates that immediate attention is required, a rating of 2 that attention should be given within 10 minutes, while 5 suggests a non-urgent case requiring attention within 4 hours.

Project recruitment

Two weeks after the accident the child and his or her parents were sent an information sheet about the project accompanied by an introductory letter explaining that a researcher would shortly contact them. One week later the family was telephoned, invited to participate in the study, and, if they agreed, a date arranged for the interview.

Assessment

To ensure that children had an opportunity to express openly their own account of the accident they were interviewed when possible without their parents present. Most interviews were conducted alone with the child (68.9%) in his or her own home (86.6%). For younger children this was not appropriate and if a parent was present care was taken to direct all questions towards the child and to minimise parental involvement and question answering.

Semistructured interview

A semistructured interview was developed which incorporated the clinician administered post-traumatic stress disorder scale for children (CAPS-C).[18] This scale systematically assesses each of the diagnostic criteria for post-traumatic stress disorder as detailed by DSM-IV.[11] Fulfilment of the criteria requires the presentation of specific symptoms indicating that the traumatic event is regularly re-experienced, that trauma related stimuli are avoided, and that the individual has experienced a measurable increase in arousal. The resulting disturbance has to cause clinically measurable distress or impairment in social or other areas of functioning and persist for longer than 1 month.

The semistructured interview started by inviting the child to describe in detail the accident, both the actual events and the emotions and thoughts they experienced before, during, and immediately after the accident. The interview then explored whether the child had any regular or persistent thoughts and memories about the accident which interfered with ability to concentrate--for instance, intrusive thoughts or flashbacks. A range of emotional changes were assessed, including the presence of severe anxiety, sleeping and eating disturbance, and relevant alterations in mood state such as extreme unhappiness or depression, irritability, and anger. The effect of the accident on the child's everyday life was discussed and any avoidance, extreme panic, or hypervigilance noted. Any changes after the accident in the child's social life, school work, friendships, and relationships with family members were assessed. Finally, the way in which the child coped with the psychological consequences arising from the accident were identified.