Stepped Preventive Care to Reduce the Impact of Acute Pediatric Injury

每6名儿童中就有1名出现持续的、损害的症状 创伤后应激障碍(PTSD)，但大多数都没有得到诊断和治疗。创伤后应激障碍和其他后遗症 可能会对健康和功能结果产生重大影响，但医疗提供者对伤害相关的意识 创伤应激是有限的。医院创伤计划为继发性创伤提供了独特的机会 预防持续性精神困扰和促进受伤儿童的最佳健康结果。 关于预防创伤后应激障碍的专家共识建议呼吁包括筛查在内的分步护理， 对有风险的人进行跟踪，并根据个人需求进行循证干预。尽管 儿童伤害相关创伤后应激障碍的记录影响，尚未对受伤的患者进行评估 孩子们。 目的：我们建议进行一项随机有效性试验，以解决以下具体目标： 1)评估干预对心理社会结局(创伤后应激障碍和抑郁症状)的影响； 2)评估其对健康结果的影响(遵守出院指示、与健康有关的生活质量)； 3)提供初步数据，以便进行成本效益分析：说明提供 干预措施，并描述其对后续卫生服务利用的影响。 我们假设接受干预的高危儿童将有较低的创伤后应激障碍和抑郁评分， 更好的健康结果，以及更适当地使用受伤后保健服务。 研究设计：比较阶梯式预防性护理干预与常规护理的随机对照试验 包括基线、6周和6个月的评估。 单位：市一级儿科创伤中心。 研究对象：270名8岁至17岁因意外伤害入院的儿童。 干预措施：针对高危受伤儿童的阶段性预防性护理干预。 观察指标：创伤后6周和6个月的评估将评估创伤后应激障碍和抑郁。 儿童和父母的症状，依从性，以及与健康相关的生活质量。健康记录数据将 通过出院指示和受伤后6个月内的卫生服务利用率来衡量遵从性。

1 in 6 children with unintentional injuries develops persistent, impairing symptoms of posttraumatic stress disorder (PTSD) but most go undiagnosed and untreated. PTSD and other sequelae can have significant impact on health and functional outcomes, yet medical providers' awareness of injury-related traumatic stress is limited. Hospital trauma programs offer unique opportunities for secondary prevention of persistent psychosociat distress and promotion of optimal health outcomes for injured children. Expert consensus recommendations for PTSD prevention call for stepped care incorporating screening, follow-up with those at risk, and evidence-based interventions that are matched to individual need. Despite the documented impact of pediatric injury-related PTSD, no such program has been evaluated for injured children. Objectives: We propose a randomized effectiveness trial to address the following specific aims: 1) Evaluate the impact of the intervention on psychosocial outcomes (PTSD and depression symptoms); 2) Evaluate its impact on health outcomes (adherence to discharge instructions, health-related quality of life); 3) Provide preliminary data to inform cost-effectiveness analyses: describe the costs of providing the intervention and describe its impact on subsequent health service utilization. We hypothesize that at-risk children receiving the intervention will have lower PTSD and depression scores, better health outcomes, and more appropriate use of post-injury health services. Study Design: Randomized controlled trial comparing Stepped Preventive Care intervention to usual care, with baseline, 6 week, and 6 month assessments. Setting: Urban Level I Pediatric Trauma Center. Participants: 270 children age 8 to 17 admitted for unintentional injury. Interventions: Stepped Preventive Care intervention for at-risk injured children. Outcome Measures: Assessments 6 weeks and 6 months post-injury will evaluate PTSD and depression symptoms in children and parents, adherence, and health-related quality of life. Health record data will gauge adherence with discharge instructions and health service utilization over the 6 months post-injury.