Cox CM, Kenardy JA, Hendrikz JK. A meta-analysis of risk factors that predict psychopathology following accidental trauma. J Spec Pediatr Nurs. 2008;13(2):98-109.

REVIEWER INTRODUCTION

Unintentional injury is one of the leading causes of death and disability in children. In addition to the physical trauma, accidental pediatric injuries may cause psychological distress. While most children are able to adapt and move on after the acute phase, there are children who suffer posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS). Risk factors associated with the potential to cause long-term suffering can be divided into 3 categories or variables: pretrauma, trauma-related, and posttrauma recovery. The authors report many inconsistencies in the literature as to which risk factors are a predictor of poor adjustment in children following accidental trauma.

STUDY METHODS AND RESULTS

The authors examined the relationship between potential risk factors and PTSD or PTSS in children who had experienced an accidental trauma by performing a meta-analysis of 14 studies. Eleven of the 14 studies focused only on children who were victims of road traffic accidents. To be included in the review, studies needed to report (a) reliability and validity of measures, (b) severity or diagnosis of PTSD and PTSS, and (c) self-reports of the child or adolescent's reaction to the accidental traumatic injury within 1 year of the injury. The 8 risk factors examined in the meta-analysis were age, gender, pretrauma psychopathology, exposure to prior trauma, injury severity, threat to life, involvement of family or friends, and posttrauma parental distress.

Since a variety of statistical analyses were employed in the studies, the authors used the correlation coefficient r to convert the statistics to 1 common effect size. This allowed them to compare linear associations with adverse psychological outcomes.

All the 14 studies analyzed were prospective and children's ages ranged from 5 to 18 years. Four studies included child self-reports and 10 contained both child and parent reports.

Perceived threat to life, a trauma-related variable, was strongly linked to long-term adjustment difficulties. Pretrauma psychopathology such as emotional and behavioral problems had high predictive power as did posttrauma parental distress. However, even with a robust relationship, posttrauma parental distress exhibited significant heterogeneity (varied effects) so it is difficult to extrapolate the predictability of this factor. Results indicated a consistent link between females and posttrauma PTSD or PTSS, although the authors did not find the relationship to be significantly strong.

COMMENTARY

In addition to treating the pediatric trauma patient's physical injuries, nurses need to be cognizant of the psychological impact of the trauma on the child. While the researchers concede that there are limitations to the meta-analysis and caution that the results should be explored further, they do raise awareness that certain factors place the child at a greater risk for posttraumatic stress. If nurses had access to an evidence-based screening tool to help identify children at risk for developing posttraumatic distress disorders, perhaps more adverse outcomes could be prevented and trauma nurses could lead the efforts.