PC1019: Use of the Psystart Rapid Mental Health Triage System with Pediatric Traumatic Injury Patients in the Emergency Department

Background:

Background: Traumatic injury is the leading cause of death and disability among youth. Post-traumatic stress disorder (PTSD) is common after trauma, occurring in an estimated 20-30% of injured children. Mitigating PTSD is most successful when intervention is performed before symptoms become fulminant and entrenched with secondary functional impairment and co-morbidities. To guide early intervention, we sought to prospectively evaluate PsySTART® a triage tool that aids identification of children who are at increased risk for developing PTSD after acute trauma experiences.

Methods:

Methods: Children ages 8-17 years presenting for emergency department trauma evaluation at a freestanding quaternary children’s hospital between 06/2019 and 07/2021 were eligible for enrollment. Children were excluded if they were wards of the state or likely to face criminal charges; victims of intentional trauma; requiring immediate psychiatric intervention; Glasgow Coma Scale of 3-12, neurocognitively impaired or had a medical condition preventing assent and follow-up; deaf and/or unable to converse in English. Bedside trauma nurses screened eligible children using PsySTART® without asking them any questions directly. Legal guardians were consented for enrollment upon arrival. If enrolled, guardians completed a questionnaire that included demographics and child’s past medical and social history. Vital signs and pain score on ED arrival, past medical history, clinical interventions during the encounter, and ED disposition were abstracted from the medical record. Children were contacted by phone after 30 days to complete an interview which included assessment of intervening life stressors, mental health service utilization, and the Child PTSD Symptom Scale for DSM-V (CPSS-5). Only children who completed the follow-up were included in the analysis. Fisher’s exact test was used to examine the association between PsySTART® and PTSD. Performance of PsySTART® was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value.

Results:

Results: 250 children were enrolled in the study between 06/2019 and 07/2021; 213 completed the follow-up call. Median age of the cohort was 12.7 years (IQR 11-14.9). The majority were male (62%), White (73%) and/or non-Hispanic (96%). The most common mechanism was motor vehicle crash (27%). Fifty-five (26%) children had a CPSS score >or= 21, indicating moderate PTSD symptoms and appropriateness for trauma-focused treatment. Table 1 shows the performance of the individual PsySTART® elements. Table 2 shows the performance of PsySTART® score of >or= 2, stratified by age, gender, and prior stressful life events.

Conclusion:

Conclusion: In this cohort of children experiencing trauma, total PsySTART® score at the time of ED encounter had modest sensitivity for prediction of future PTSD symptoms and its performance improved as a function of age, gender, and prior stressful life events. A large multi-center trial is needed to further develop a version of PsySTART® for use in triaging injured children in a “stepped” behavioral health care approach to mitigating PTSD.