Emergency department evaluation of acute stress disorder symptoms in violently injured youths.
OBJECTIVE
We assess the feasibility of evaluating acute stress disorder (ASD) symptoms in the emergency department and provide an initial estimate of the prevalence, severity, and variability of these symptoms in violently injured urban children and young adults.


METHODS
The Immediate Stress Response Checklist (ISRC) was administered to violently injured patients between the ages of 8 and 24 years who presented to 2 urban, academic medical center EDs during a 10-week period. The ISRC is designed to assess ASD symptoms in children and youths immediately after a traumatic event. Responses are described using summed symptom severity scores and counts of symptoms.


RESULTS
Out of 109 identified youths, 81 participated. Fear, helplessness, or horror during the injury event was reported by 59 (73%) of study participants. Each of the following categories of ASD symptoms was reported by a significant number of youths: peritrauma dissociation, 63 (78%); posttrauma dissociation, 33 (41%); re-experiencing intrusive thoughts or images, 66 (82%); avoidance, 53 (65%); and hyperarousal, 32 (39%). The ISRC demonstrated high internal consistency (Cronbach alpha=.88) in this cohort.


CONCLUSIONS
The ISRC can be used to assess acute stress reactions in violently injured youths in the immediate period after injury. Although these reactions appear to be common, there is substantial variability among distinct symptom categories. These results support the need for further investigation of the relationship between immediate stress responses and longer-term emotional impact of violent injury. Clinicians should consider assessing the emotional responses of children and adolescents who are injured by interpersonal violence, even when these injuries seem minor.
Fein
J A
JA
Division of Emergency Medicine, The Children's Hospital of Philadelphia, PA 19104, USA. fein@email.chop.edu
Kassam-Adams
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Datner
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D000046:Academic Medical Centers; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015143:Philadelphia / Q000453:epidemiology; D011336:Probability; D012307:Risk Factors; D012494:Sampling Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D014505:Urban Population; D014754:Violence / Q000523:psychology*; D014947:Wounds and Injuries / Q000523:psychology*