Article
The Impact of Unintentional Pediatric Trauma: A Review of Pain, Acute Stress, and Posttraumatic Stress

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This article reviews current research on acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) resulting from pediatric simple (i.e., single, unpredictable, and unintentional) physical injury and how pain may act as both a trigger and a coexisting symptom. Although several studies have explored predictors of ASD and PTSD, as well as the relationship between these conditions in adults, there is less research on ASD and PTSD in children and adolescents. This review highlights the importance of early detection of pain and acute stress symptoms resulting from pediatric unintentional physical injury in the hopes of preventing long-term negative outcomes, such as the potential development of PTSD and associated academic, social, and psychological problems.

Section snippets

Definition of ASD and PTSD

ASD and PTSD are anxiety disorders that can result when a person experiences, witnesses, or is confronted by an event involving actual or threatened death or serious injury to oneself or others, or if a person's physical integrity is threatened (American Psychiatric Association, 1994). Events linked with the development of ASD or PTSD include interpersonal violence with or without direct victimization (e.g., physical or sexual abuse, torture), severe motor vehicle accidents (MVAs), war

Adults: Pain, ASD, and PTSD

Evidence has supported the relationship between pain resulting from traumatic physical injury and the development of ASD and PTSD in adults. One study examined 323 adult accident victims and assessed numerous accident- and ASD-related variables (Fuglsang, Moergeli, Hepp-Beg, & Schnyder, 2002). They found three constellations summing nine variables, including two objective accident-related variables (traffic accident and admission to the intensive care unit), two pretrauma and trait variables

Clinical Recommendations

Although investigators have separately identified the predictive role of physiological indices, acute physiological reactivity (e.g., hyperarousal), acute pain, and ASD in the development of PTSD, this article emphasizes their complex interplay. Identifying relationships between these variables will inform and enhance medical and psychological care for children and adolescents following traumatic physical injury. This section will highlight recommendations for early identification of, and

Conclusions

This article is the first comprehensive review of the proposed interaction of acute stress reactions, PTSD, and the role of pain as it pertains to pediatric unintentional physical injury. In addition to presenting the current literature on the relationship between ASD and PTSD, the authors have discussed the role of pain in triggering the deleterious effects of trauma. This article concludes with clinical recommendations for early assessment, reassessment, and pharmacological and psychological

References (71)

  • A. Kuhne et al.

    Efficacy of chemical dependency treatment as a function of combat in Vietnam

    Journal of Substance Abuse and Treatment

    (1986)
  • R.D. Marshall et al.

    Psychobiology of the acute stress response and its relationship to the psychobiology of post-traumatic stress disorder

    Psychiatric Clinics of North America

    (2002)
  • F. Pillemer et al.

    Psychological considerations in youth sports

    Clinics in Sports Medicine

    (1988)
  • R.K. Pitman

    Post-traumatic stress disorder, hormones, and memory

    Biological Psychology

    (1989)
  • S.L. Ratcliff et al.

    The effectiveness of a pain and anxiety protocol to treat the acute pediatric burn patient

    Burns

    (2006)
  • G. Saxe et al.

    Relationship between acute morphine and the course of PTSD in children with burns

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2001)
  • E.D Schwarz et al.

    Malignant memories: PTSD in children and adults after a school shooting

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1991)
  • F.J. Stoddard et al.

    Ten-year research review of physical injuries

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2001)
  • S. Taylor et al.

    Anxiety disorders due to motor vehicle accidents: Nature and treatment

    Clinical Psychology Review

    (1995)
  • J. Aaron et al.

    Posttraumatic stress in children following acute physical injury

    Journal of Pediatric Psychology

    (1999)
  • H. Abdullah et al.

    Visible scars and self-esteem in pediatric patients with burns

    Journal of Burn Care & Rehabilitation

    (1994)
  • American College of Surgeons

    National Trauma Data Bank annual report (Version 6.0)

    (2006)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders (DSM-IV)

    (1994)
  • J.M. Anderson et al.

    Spinal injury in children: A review of 56 cases seen from 1950 through 1978

    Mayo Clinic Proceedings

    (1980)
  • C.R. Brewin et al.

    Acute stress disorder and posttraumatic stress disorder in victims of violent crime

    American Journal of Psychiatry

    (1999)
  • R.A. Bryant et al.

    A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder

    Journal of Abnormal Psychology

    (2000)
  • R.A. Bryant et al.

    Relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury

    American Journal of Psychiatry

    (1998)
  • B. Bursch et al.

    Pediatric chronic pain

    American Pain Society Bulletin

    (2001)
  • J.T. Chibnall et al.

    Post-traumatic stress disorder and motor vehicle accidents

    Headache

    (1994)
  • C. Classen et al.

    Acute stress disorder as a predictor of posttraumatic stress symptoms

    American Journal of Psychiatry

    (1998)
  • F. Cohen et al.

    Active coping processes, coping dispositions, and recovery from surgery

    Psychosomatic Medicine

    (1973)
  • A.P. de Vries et al.

    Looking beyond the physical injury: Posttraumatic stress disorder in children and parents after pediatric traffic injury

    Pediatrics

    (1999)
  • J. Difede et al.

    Acute stress disorder after burn injury: A predictor of posttraumatic stress disorder?

    Psychosomatic Medicine

    (2002)
  • M. Drottning et al.

    Acute emotional response to common whiplash predicts subsequent pain complaints: A prospective study of 107 subjects sustaining whiplash injury

    Nordic Journal of Psychiatry

    (1995)
  • G. Dyb et al.

    Parent–child discrepancy in reporting children's post-traumatic stress reactions after a traffic accident

    Nordic Journal of Psychiatry

    (2003)

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