Short CommunicationHeart rate as a predictor of posttraumatic stress disorder in children
Introduction
Fear conditioning models posit that enhanced adrenergic activation in the acute phase after trauma leads to fear conditioning and subsequent posttraumatic stress disorder (PTSD) [1]. Consistent with this proposal, studies of adults have demonstrated that elevated resting heart rate (HR) in the first week after trauma predicts PTSD [2], [3], [4], [5], [6], [7]. Although one study reported higher HR in those without PTSD, this study was methodologically flawed [8]. Although this pattern raises the possibility of screening for patients at high risk for PTSD, the predictive accuracy of most studies has been limited and optimal prediction has been attempted by combining HR with other psychological predictors [3]. One study that examined the possibility that HR can predict PTSD in children found that children and adolescents who developed full or subsyndromal PTSD displayed higher HR in the emergency department than those who did not develop PTSD [9]. The current study assessed HR in children who were admitted to hospital after traumatic injury, assessed them for acute stress disorder (ASD) within a month of trauma and subsequently assessed them for PTSD 6 months after trauma. This study extended on the previous research by focusing on children from a range of traumatic experiences, using HR measured after discharge from the emergency department, and assessed ASD in the initial month, as well as PTSD 6 months after injury. We hypothesized that children who develop PTSD will display higher HR in the acute phase than those who do not develop PTSD.
Section snippets
Participants
Inclusion criteria were as follows: participants must be between 7 and 12 years of age; they should be a survivor of a traumatic fall, motor vehicle accident or other traumatic injury; they should possess adequate English skills; and there should be absence of traumatic brain injury. There were 241 consecutive admissions over a 20-month period but 60 could not be contacted, 98 declined to participate and 7 lived too distant from the hospital. Seventy-six children (50 males and 26 females) were
Diagnostic outcomes
We considered subsyndromal PTSD (defined as meeting reexperiencing and either avoidance or arousal clusters) because of proposals that this level of symptoms can be associated with impairment [13]. We analyzed HR data in terms of subsyndromal and full diagnostic criteria. Seven children (10%) met criteria for ASD, and 56 (90%) had no ASD. At the follow-up, 8 children (13%) met criteria for PTSD, 9 had subsyndromal PTSD (14%) and 45 (73%) had no PTSD. Table 1 indicates that PTSD patients were
Discussion
Different HR levels in children with PTSD, rather than ASD, point to the possibility that fear conditioning may contribute to symptom development in the longer term after trauma exposure. The current data suggest that caution should be exercised about this possibility because the sensitivity (47%) and specificity (84%) of elevated HR levels was modest. In this sense, HR appears to provide better specificity to exclude children who are unlikely to develop PTSD than sensitivity to identify those
Acknowledgments
This research was supported by a National Health and Medical Research Council Program Grant (300304).
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