Children at risk: A prospective cohort study of acute stress development and patterns in pediatric trauma patients

Background: Children are at significant risk for acute stress after injury which can impair a child's return to prior level of function. Early diagnosis is key to early intervention and reduced impact. This study evaluates factors associated with development and persistence of acute stress symptoms in children after injury.

Methods: A prospective cohort study was conducted of children 7-17 years admitted to a level 1 pediatric trauma center (2020-2024). Patients underwent acute stress screening at discharge and were categorized as asymptomatic (score 0), symptomatic (score 1-5), or positive (score 6+). Symptomatic and positive patients received a follow-up survey one month after discharge. Descriptive statistics, univariate, and multivariable logistic regression were used to evaluate factors associated with positive score at discharge and one month.

Results: A total of 603 patients were screened at discharge; 143 were asymptomatic and 460 were symptomatic or positive. Younger age, female sex, Black race, assault as intent of injury and greater neighborhood deprivation level were associated with positive score, on multivariable analysis only age and sex were associated with positive score. A total of 460 patients (76.3 %) had a score of ≥1 at discharge and were eligible for a follow-up call. The follow-up screening was completed by 237 patients (51.5 %). A total of 40 (16.8 %) were positive at one month and 197 (83.1 %) scored negative.

Conclusions: Most children who have symptoms of acute stress at discharge had symptom resolution at one month, however some patients remain positive or develop worsening symptoms. These findings can guide upfront interventions to address acute stress after injury.