Research In Action
Research In Action
An accident or injury can be a very frightening and stressful experience for children and their families. In the first few days after an injury, it is common for nearly all children to feel upset, on edge, or worried at times. While these reactions often improve within a few weeks, 5 in 6 injured children have acute traumatic stress and 1 in 6 of these children may develop persistent PTSD symptoms. Early screening and support can help support coping, but how do healthcare providers best screen injured patients and what is required of them?
In its standards for verification and review of trauma centers, the American College of Surgeons (ACS) states that trauma centers must have either structured mental health screening and referral protocol [Level I and II centers], or clear mental health referral process [Level III centers]. However, how do trauma centers responding to these guidelines know how to best implement evidence-based screening and referral processes?
Developing Practice Management Guidelines
We at Center for Pediatric Traumatic Stress partnered with the Pediatric Trauma Society (PTS) and the Society for Trauma Nurses in a formal evidence review process to develop practice management guidelines regarding mental health screening in pediatric injury patients. Our work was recently published in the Journal of Trauma and Acute Care Surgery in March 2025.
In our systematic review, we used a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) Approach and asked the following questions, in lay language:
- Should only those patients perceived to be at risk for psychological symptoms be screened or should all patients with injury be screened?
- Which screening tool(s) should be used to identify those at risk for current psychological symptoms?
- Which screening tool(s) should be used to identify those at risk for later psychological symptoms?
Recommendations for Mental Health Screening
Universal mental health screening among pediatric patients with injury to identify those most at-risk for mental health difficulties was the strongest recommendation arising from our review. The extremely minimal risk of harm in universal screening was strongly outweighed by the benefits of universal screening (which include efficient and accurate referrals for care, potential for improved patient function, and lower patient distress) as well as the risk of harm from not identifying children experiencing mental health distress. .
Given the limited data available on relevant screening tools, in lieu of voting on recommendations for screening tools, the authors instead developed Essential and Desirable Criteria for a screening tool and applied it to the tools they found. The criteria were developed collaboratively and a qualitative process was used to evaluate which screening tools met criteria to be recommended for clinical use.
Upcoming Webinar for Additional Support Around Screening
In addition to reviewing our publication or HealthcareToolbox.org, trauma centers needing additional support around screening are invited to attend an upcoming webinar hosted by Pediatric Trauma Society. This webinar, held May 9th from 12-1pm EST, will be open to all attendees regardless of PTS membership, and will provide opportunity for the paper’s authors to:
- Provide a brief overview of mental health and pediatric injury
- Present findings and recommendations from their paper o
- Offer guidance and resources on implementing screening practices
- Engage in Q&A
Additional resources related to pediatric injury and medical traumatic stress include:
- AfterTheInjury.org
- Infographics created by CPTS for Pediatric Trauma Society:
- PTS members are also able to attend quarterly consultation calls with psychologists.
