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Background: The present study investigated the extent to which heart rate (HR) levels soon after a traumatic event predicted posttraumatic stress disorder (PTSD) symptom severity assessed 6 weeks and 6 months later in child trauma victims. Methods: Participants consisted of 82 children (56 boys, 26 girls) aged 8-18 who were admitted to a Midwestern trauma center. HR data were recorded from emergency medical services (EMS) records, upon admission to the emergency department (ED), for the first 20 minutes following admission, and upon discharge. Subsequent PTSD and depressive symptoms were assessed 6-weeks and 6-months post-trauma. Results: HR recorded during EMS transport was significantly correlated with PTSD symptoms at 6 weeks (r = 0.42) and at 6 months (r = 0.35). After removing the variance associated with demographic variables and depressive symptoms, HR during EMS transport and averaged over the first 20 minutes following admission significantly predicted 6-week PTSD symptoms. The first recorded EMS HR measure significantly predicted 6-month PTSD symptoms. HR averaged over the first 20 minutes of EMS transport and averaged over the first 20 minutes following admission marginally predicted 6-month PTSD symptoms (ps = 0.051 and 0.079, respectively). Conclusions: The present findings suggest that physiological arousal soon after a traumatic event may be associated with increased risk for the development of PTSD symptoms in child trauma victims. These findings provide preliminary support for the use of acute cardiovascular levels as markers of child trauma victims at higher risk of developing symptoms of PTSD.

BACKGROUND. Nonpharmacologic interventions, such as distraction, have been shown to be powerful adjuncts in reducing pain and anxiety in children with both acute and chronic painful conditions. There are no controlled studies evaluating these interventions as adjuncts to facilitate completion of painful procedures in the pediatric emergency department (ED). OBJECTIVE. We assessed the effectiveness of distraction techniques in reducing the sensory and affective components of pain among pediatric patients undergoing laceration repair in the ED. METHODS. Eligible children between 6 and 18 years of age (N = 240) presenting to the ED for laceration repair were randomly assigned to an intervention or control arm. Those assigned to the intervention arm were given a choice of age-appropriate distracters during laceration repair. Quantitative measures of pain intensity, situational anxiety, and pain distress (as perceived by the parent) were assessed by using the 7-point Facial Pain Scale, State Trait Anxiety Inventory for Children, and a visual analog scale, respectively, before and after laceration repair. The State Trait Anxiety Inventory for Children was performed in children [greater than or equal to] 10 years of age. RESULTS. There was no difference in mean change in Facial Pain Scale scores between the control and the intervention groups in children < 10 years of age. Multivariate analysis in this same age group showed that the intervention was independently associated with a reduction in pain distress as perceived by parents based on the mean change in visual analog scale scores. In older children, the intervention was independently associated with reduction in situational anxiety but not in pain intensity or in parental perception of pain distress. CONCLUSIONS. The use of distraction techniques is effective in reducing situational anxiety in older children and lowering parental perception of pain distress in younger children. This technique may have a role in improving the quality of management of procedural pain in a pediatric ED setting. Key Words children, pain, distraction, emergency Abbreviations ED--emergency department FPS--Facial Pain Scale VAS--visual analog scale STAIC--State Trait Anxiety Inventory for Children, THE INTERNATIONAL ASSOCIATION for the Study of Pain defines pain as an "unpleasant sensory and emotional experience associated with actual or potential tissue damage." Pain is the single most common […]

Doctors who want to do a blood test on children to see if they have a bacterial infection should not take the blood from an intravenous catheter. The blood may be contaminated with bacteria from the surface of the skin, which would give a false-positive result. This was the conclusion of a study of 4,108 children.

ABBREVIATIONS. ED, emergency department; SEP ED, separate pediatric and adult EDs; COMB ED, combined adult and pediatric ED; COMTY ED, community hospital with a combined ED. Controversy continues to surround [...]