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

The interview format was revised and restructured during the pilot study, during which 19 children who had been involved in road traffic accidents were assessed. Data from these children were not included in the final analysis. Reliability between assessors of the interview was determined by randomly selecting eight interviews, which were rated blind by a second researcher. Agreement between the two raters on their coding of responses to the 101 questions that formed the semistructured interview was 93.1%. There was total agreement between the two raters as to which of the diagnostic criteria for post-traumatic stress disorder each of the eight children fulfilled.

Psychometric assessment

The children completed a battery of psychometric assessments that assessed the effect of the trauma (impact of events scale[19]), the presence of depression (Birleson depression inventory[20]), and anxiety (revised manifest anxiety scale[21]). The Birleson depression scale has not been validated on younger children and because of uncertainty regarding the appropriateness of some items it was decided to administer the psychometric assessments only to children over the age of 7.

Researchers

Interviews were conducted by one of four researchers. To standardise the assessment process the researchers worked with each other and conducted a number of joint interviews.

Statistical methods

Categorical data were analysed with non-parametric [chi square] statistics and continuous data by two tailed t tests.

Results

Road traffic accident group

A total of 278 children attended the department after involvement in road traffic accidents. One child died, one was in a coma, and one was untraceable at the time of follow up, leaving a study group of 275 children. Of these, 147 refused to be interviewed, although 29 agreed to complete and returned the battery of psychometric assessments. Of the 128 who agreed to participate, 119 were successful interviewed with the nine remaining being out at the agreed appointment time, and further attempts to interview them proved unsuccessful. Therefore 43% of all children involved in road traffic accidents were interviewed between 22 and 79 days after their accident (mean (SD) 40.3 (9.82) days). The diagnosis of post-traumatic stress disorder requires symptoms to persist for longer than 1 month, and three children were interviewed before this time. Data from these children were included in the analysis, although none fulfilled the other diagnostic criteria for the diagnosis for post-traumatic stress disorder. A comparison of children who were interviewed with those who were not is provided in table 1. There were few significant differences between the groups. Interviewees were more likely to require treatment within 10 minutes and to be admitted.

Table 1 Children involved in road traffic accidents: comparison between interviewees and non-interviewees. Values are numbers (percentages) of subjects unless stated otherwise

                                                        Not
                                     Interviewed    interviewed
Detail                                 (n=119)        (n=157)

Mean (SD) age (years)                13.97 (3.59)   14.71 (3.32)

No of boys                              68 (57)       102 (65)

Type of accident:
  Pedestrian                            28 (24)        34 (22)
  In car that crashed                   67 (56)        95 (61)
  On cycle/motorcycle that crashed      24 (20)        28 (18)

Mean (SD) triage rating               2.67 (0.98)    3.08 (0.79)

Priority rating 1 or 2 (treatment
  within 10 minutes)                    38 (32)         30 (19)

Mean (SD) No of x ray pictures        1.27 (1.32)      1.0 (1.41)

Fractured bones                         24 (20)         23 (15)

Blow to head recorded                   56 (47)         66 (42)

Admitted to hospital                    31 (26)         22 (14)

Detail                               P value

Mean (SD) age (years)                 0.075

No of boys                            0.186

Type of accident:
  Pedestrian
  In car that crashed
  On cycle/motorcycle that crashed    0.078

Mean (SD) triage rating               0.001

Priority rating 1 or 2 (treatment
  within 10 minutes)                  0.016

Mean (SD) No of x ray pictures        0.119

Fractured bones                       0.246

Blow to head recorded                 0.438

Admitted to hospital                  0.014