title: An evaluation of posttraumatic stress disorder and parent stress in children with orthopaedic injuries.
abstract: OBJECTIVE
  Trauma has more than physical effects on pediatric patients and their families. The purpose of this study was to evaluate pediatric orthopaedic trauma patients and patients with isolated nonoperative upper extremity (UE) fractures for emotional/psychologic symptoms associated with posttraumatic stress disorder (PTSD) and parent stress.
  
  
  METHODS
  An institutional review board-approved prospective study of patients aged 8-18 years who sustained a traumatic injury or isolated UE fracture from October 2009 to May 2010 was performed. Demographic data were obtained and the Child PTSD Symptom Scale was used. The Parent Stress Index was used to evaluate the stress of the parents/guardian. For 80% power, we needed 32 per group. P value was set at <0.05.
  
  
  RESULTS
  A total of 76 children and their parents/guardians participated in the study. The mean age was 12.6 years (8-17 years). There were 56 males (74%) and 20 females (26%). The average time since injury was 12 months (3-89 months). The prevalence of PTSD between the high-energy trauma patients and the low-energy nonoperative UE patients was not significant. Overall, 33% of the children had PTSD. Involvement in music was significant between patients with and without PTSD (P = 0.037) and may be protective against PTSD.
  
  
  CONCLUSIONS
  PTSD commonly affects pediatric patients who sustain injuries as a result of a traumatic event, whether low- or high-energy mechanisms. We found no factors significantly associated with or predictive of PTSD and did not find an association of PTSD with parent stress. We need to maintain a high index of suspicion in pediatric trauma patients regardless of the energy associated with the traumatic event.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Saint Louis University, St Louis, MO 63110, USA.
authors.forename: Maegen
authors.initials: M
authors.lastname: Wallace
authors.forename: Aki
authors.initials: A
authors.lastname: Puryear
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Cannada
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000523:psychology*; D006801:Humans; D008297:Male; D009141:Musculoskeletal System / Q000293:injuries*; D010290:Parents / Q000523:psychology*; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology; D034941:Upper Extremity / Q000293:injuries*; D014947:Wounds and Injuries / Q000523:psychology