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

Scores on the psychometric screening battery of those young people aged between 7 and 18 years of age who were not interviewed but returned questions (n = 29) were compared with those within this age range who were interviewed (n = 109). The results summarised in table 2 found no significant differences between the groups on any measure.

Table 2 Comparison of mean (SD) scores on psychometric battery between interviewees and non-interviewees aged 7-18 years

                                Interviewed     Not interviewed
Assessment measure                (n=109)           (n=29)

Impact of events scale:
  Total score                   24.07 (17.28)    23.34 (12.37)
  Intrusion scale               11.26 (9.70)     11.38 (8.30)
  Avoidance scale               12.83 (9.70)     11.97 (6.91)

Birleson depression inventory    8.72 (5.85)      9.17 (7.05)

Manifest anxiety scale          10.25 (7.53)      9.66 (6.10)

Assessment measure              P value

Impact of events scale:
  Total score                    0.832
  Intrusion scale                0.951
  Avoidance scale                0.655

Birleson depression inventory    0.727

Manifest anxiety scale           0.697

The prevalence of post-traumatic stress disorder (that is, the proportion of children in the sample with post-traumatic stress disorder) was 41/119 (34.5%; 95% confidence interval 25.91% to 42.99%). In effect this gives a prevalence of 34% (26% to 43%) for post-traumatic stress disorder in survivors of road traffic accidents. A comparison of those children who experienced post-traumatic stress disorder and those who did not is presented in table 3. Children who had experienced a previous trauma or who perceived their accident as life threatening were more likely to present with post-traumatic stress disorder. Sex was also important with a 19% risk of post-traumatic stress disorder in boys and 55% in girls, giving a relative risk of 2.89. The odds ratio of the disorder in girls relative to boys was 5.15 (2.27 to 11.67).

Table 3 Comparison of road traffic survivors with and without post-traumatic stress disorder (PSTD). Values are numbers (percentages) of subjects unless stated otherwise

Detail                               PTSD (n=41)    No PTSD (n=78)

Mean (SD) age at accident            13.56 (3.65)    14.18 (3.57)

Age (years):
  5-9                                    8 (20)         10 (13)
  10-14                                 13 (32)         24 (31)
  15-18                                 20 (49)         44 (56)

Boys                                    13 (32)         55 (71)

Type of accident:
  Pedestrian                            10 (24)         18 (23)
  In car that crashed                   25 (61)         42 (54)
  On cycle/motorcycle that crashed       6 (15)         18 (23)

Others injured:
  Yes                                   29 (71)         51 (65)
  No                                    12 (29)         25 (32)

Appraisal of life threat:
  Thought would die                     21 (51)         14 (18)

Previous experience of trauma in
  past 12 months                        16 (39)         13 (17)

Mean (SD) triage rating               2.41 (0.91)     2.79 (0.99)

Priority rating 1 or 2 (treatment
  within 10 minutes)                    16 (39)         22 (28)

Mean (SD) No of x ray pictures        1.54 (1.33)     1.12 (1.30)

Fractured bones                          9 (22)         15 (19)

Blow to head recorded                   17 (42)         39 (50)

Admitted to hospital                    11 (27)         20 (26)

Detail                                P value

Mean (SD) age at accident              0.375

Age (years):
  5-9                                  0.579
  10-14
  15-18

Boys                                 < 0.001

Type of accident:
  Pedestrian                           0.545
  In car that crashed
  On cycle/motorcycle that crashed

Others injured:
  Yes                                  0.687
  No

Appraisal of life threat:
  Thought would die                  < 0.001

Previous experience of trauma in
  past 12 months                       0.01

Mean (SD) triage rating                0.067

Priority rating 1 or 2 (treatment
  within 10 minutes)                   0.100

Mean (SD) No of x ray pictures         0.114

Fractured bones                        0.727

Blow to head recorded                  0.341

Admitted to hospital                   0.920