Simple questions used in screening kids for PTSD

The Screening Tool for Early Predictors of PTSD (STEPP) is the first method available for emergency physicians to quickly and effectively assess the risk of post-traumatic stress disorder (PTSD), says Nancy Kassam-Adams, MD, associate director for behavior research at TraumaLink, a pediatric trauma research center based at Children’s Hospital in Philadelphia.

Emergency physicians can use the STEPP to help determine who should be referred for psychological evaluation and intervention so that families can avoid PTSD, she says.

Kassam-Adams and her colleagues found that severity of injury is not necessarily a predictor of PTSD. Instead, a combination of event-related factors, early physiological reactions such as heart rate, and early psychological responses serves to predict future development of PTSD.

STEPP was developed in a population of children who had traffic-related injuries and their parents. The STEPP method includes four yes/no questions asked of the parent, four yes/no questions asked of the child, and four items easily obtained from medical records. Kassam-Adams says these are the 12 questions included on the screening tool:

• For the parent:

1. Did you see the incident (accident) in which your child got hurt?

2. Were you with your child in an ambulance or helicopter on the way to the hospital?

3. When your child was hurt (or when you first heard it had happened), did you feel really helpless, like you wanted to make it stop happening, but you couldn’t?

4. Does your child have any behavior problems or problems paying attention?

• For the child:

5. Was anyone else hurt or killed (when you got hurt)?

6. Was there a time when you didn’t know where your parents were?

7. When you got hurt, or right afterward, did you feel really afraid?

8. When you got hurt, or right afterward, did you think you might die?

• From the medical record:

9. Is there a suspected extremity fracture?

10. Was the pulse rate at ED triage > 104/minute if the child is younger than 12 years or > 97/ minute if the child is 12 years or older?

11. Is the child 12 years or older?

12. Is the child a girl?

To assess the results, Kassam-Adams says the provider scores one point for each yes answer and zero points for a no answer. Parents’ likelihood of suffering PTSD is scored by adding up the yes answers on questions 1, 2, 3, 4, 9, and 11. A score of 3 or more yes answers is a positive result.

A child’s assessment is based on questions 5, 6, 7, 8, 9, 10, and 12. A score of 4 or more yes answers is a positive result.