Predicting PTSD Risk in Children After Acute Traumatic Events

描述（由申请人提供）：急性单一事件创伤是儿童和青少年不幸的常见经历。伤害、灾害和其他急性创伤每年影响数百万儿童。在单一事件中，伤害在流行率和公共卫生影响方面都很突出。许多遭受创伤的年轻人恢复得很好，但相当多的人出现了严重的创伤后应激障碍症状，损害了心理功能以及学术和社会发展。临床医生和研究人员都非常需要在创伤后早期进行有效的筛查策略，以可靠地识别创伤暴露儿童中发生持续性PTSD症状的最高风险。在儿童创伤后早期的多个时间点设计的简短的筛查工具，并适合于由一系列从业人员使用，将有最大的公共卫生影响。这些工具可以将筛查和预防工作的范围扩大到儿科医疗环境，从而使不太可能寻求正式心理健康服务的创伤暴露儿童参与进来。这项研究的长期目标是开发和测试风险评估工具，用于在急性创伤暴露后的多个时间点对儿童进行筛查。拟议的项目将采用现有数据的二次分析，这些数据来自前瞻性评估急性儿童创伤（主要是儿童受伤）后的创伤后应激障碍和创伤后应激障碍的研究。这一探索性/发展性项目的具体目标是：（1）建立数据共享和协作的工作基础设施;（2）确定最佳方式，将现有数据联合收割机结合起来，以制定预测和结果变量以及预测分析;（3）进行分析，为儿童开发一套初步的风险评估工具。该项目团队将专家内容知识和方法学专业知识相结合，并将提供现有的数据集，以及有关2500多名经历过急性创伤（主要是伤害）的儿童的前瞻性数据。这些数据是在多个时间点收集的，包括回顾性创伤前特征、创伤前后人员和事件特征、住院生物学数据以及早期和后期创伤后反应。作为当前项目的一部分，研究小组将开发一个关于儿童创伤的丰富的前瞻性数据档案，以及一个协作和数据共享的基础设施，这将在项目初期产生影响。在开发风险评估工具时，计划采用的方法是设计一个多点筛查过程（早期筛查适合于创伤后即刻，后期筛查在创伤后最初几周到几个月内）。该小组将检查不同时间和单个筛查点的筛查结果组合的有效性。该项目的结果将为在不同的临床和研究环境中以及在经历过不同类型急性创伤的儿童中对顺序风险评估工具进行前瞻性测试和验证奠定基础。该项目旨在推动开发可在儿童创伤后早期使用的简要风险评估工具。这些工具将通过将筛查和预防工作的范围扩大到儿科医疗机构，使那些不太可能寻求正规精神卫生服务的创伤暴露儿童参与进来，从而对公共卫生产生重大影响。这推进了“健康人民2010”的目标，即增加在卫生保健机构接受心理健康筛查和评估的人数（目标18-6）。

DESCRIPTION (provided by applicant): Acute single-incident trauma is an unfortunately common experience for children and adolescents. Injury, disasters, and other acute traumas affect many millions of children each year. Among single-incident events, injury stands out in both prevalence and public health impact. Many trauma-exposed youth recover well, but a considerable number develop significant symptoms of posttraumatic stress disorder (PTSD) that impair psychological functioning and academic and social development. Well-validated screening strategies in the early post-trauma period are greatly needed by both clinicians and researchers, to reliably identify trauma-exposed children at highest risk of developing persistent PTSD symptoms. Brief screening tools designed for multiple time points in the early aftermath of child trauma, and suitable for use by a range of practitioners, would have the greatest public health impact. Such tools could expand the reach of screening and prevention efforts to pediatric medical settings, thus engaging trauma- exposed children unlikely to seek formal mental health services. The broad, long-term goal of this research is to develop and test risk assessment tools for screening children at multiple time points after acute trauma exposure. The proposed project will employ secondary analysis of existing data from studies that have prospectively assessed posttraumatic stress symptoms and PTSD following acute child trauma, primarily child injury. The specific aims of this exploratory / developmental project are to: 1) Establish a working infrastructure for data sharing and collaboration; 2) Determine best ways to combine available data to formulate predictor and outcome variables and predictive analyses; 3) Conduct analyses to develop a preliminary set of risk assessment tools for children. The project team combines expert content knowledge and methodological expertise, and will make available existing datasets with prospective data regarding more than 2500 children who have experienced acute trauma, primarily injury. These data were collected at numerous time points and include retrospective pre-trauma characteristics, peri-traumatic person and event characteristics, in-hospital biological data, and early and later post-traumatic responses. As part of the current project, the research team will develop a rich archive of prospective data on child trauma, and an infrastructure for collaboration and data-sharing that will have impact beyond the initial project period. In developing risk assessment tools, the planned approach is to design a multi-point screening process (an early screen suitable for the immediate post-trauma period, and later screen(s) within the first weeks to months post-trauma). The team will examine the efficacy of combinations of screening results across time and of single screening points. The results of this project will lay the groundwork for prospective testing and validation of sequenced risk assessment tools in different clinical and research settings and with children who have experienced distinct types of acute trauma. This project aims to advance the development of brief risk assessment tools that are feasible for use in the early aftermath of child trauma. Such tools would have great public health impact by expanding the reach of screening and prevention efforts to pediatric medical settings to engage trauma-exposed children unlikely to seek formal mental health services. This advances Healthy People 2010 goals to increase the number of persons seen in health care settings who receive mental health screening and assessment (Objective 18-6).