Screening for posttraumatic stress symptoms after accidental injury: Implementation of the young child PTSD screen in the acute trauma setting.

BACKGROUND

Post-traumatic stress symptoms (PTSS) in young children are underrecognized following unintentional injury, and validated screening tools for early childhood are rarely implemented in acute trauma settings. We evaluated the Young Child PTSD Screen (YCPS) administered at hospital discharge to determine screening positivity, associated clinical factors, and persistence of symptoms at one month.

METHODS

We conducted a retrospective cohort study of children aged 2-6 years admitted to a Level I pediatric trauma center following unintentional injury (November 2020-November 2024). Caregivers completed the 6-item YCPS at discharge. Children with ≥ 1 endorsed symptom were contacted one month later for repeat assessment. Demographic, injury, and hospitalization data were abstracted from the trauma registry and electronic health record. Multivariable logistic regression evaluated predictors of positive screening at discharge, and follow-up analyses assessed persistence of symptoms.

RESULTS

Of 193 screened patients, 186 met inclusion criteria. Over half (55.9%, n = 104) screened symptomatic or positive at discharge. On univariate analysis, greater injury severity score and longer length of stay were associated with symptomatic/positive screening. In multivariable analysis, injury severity remained the only significant predictor (aOR 1.07 per point increase in injury severity score, 95% CI 1.02-1.13, p = 0.004). Of eligible children, 32.6% (n = 34) completed one-month follow-up and 41.1% (n = 14) screened positive. Higher discharge YCPS scores were associated with positive follow-up (median 3 vs 2; p = 0.046) and were positively correlated with one-month scores (r²=0.21, p = 0.005). No demographic variables (age, sex, race) predicted persistence of symptoms.

CONCLUSIONS

Over one-third of traumatically injured young children screened positive for PTSS at discharge, and a substantial proportion had persistent symptoms at one month. Injury severity was associated with positive screens at discharge, while early symptom burden predicted persistence. These findings support the feasibility and clinical value of implementing developmentally sensitive screening for very young children in the inpatient trauma setting.