3033.0: Monday, November 13, 2000 - Board 9

Abstract #7898

Injury surveillance in the Emergency Department: Looking at Acute Stress Disorder symptoms in violently injured youth

Joel A. Fein, MD1, Nancy Kassam-Adams, PhD2, Tim N. Vu1, Elizabeth M. Datner, MD3, and Cara M. Vivarelli, MPH2. (1) Division of Emergency Medicine, Children's Hospital of Philadelphia, 34th St. & Civic Center Blvd, Philadelphia, PA 19104, (2) TraumaLink, Children's Hospital of Philadelphia, (3) University of Pennsylvania

Background/Objective: Current injury surveillance systems in emergency departments (ED's) often describe and track incidence and risk factors for violent injury, however, few evaluate the immediate psychological sequelae of these injuries. Acute Stress Disorder (ASD) symptoms in the early post-injury period may predict the future development of Post Traumatic Stress Disorder (PTSD), a potential outcome in youth exposed to interpersonal violence. The study objective was to assess the prevalence of ASD symptoms in urban youth injured as a result of interpersonal community violence presenting to the ED. Design/Methods: Adolescents ages 12-24 were evaluated in the two urban hospital ED's after a violent injury (excluding child and domestic abuse). Participants completed a 27-item, previously validated verbal questionnaire, rating current levels of ASD symptoms and detailing circumstances of the incident. Results: 84% of eligible patients completed questionnaires. Participants reported high levels of acute stress responses: fear/helplessness 75%; intrusive thoughts/images 82%; dissociation 66%; avoidance 66%; hyperarousal 37%. The internal consistency of the survey was high (alpha=0.87), with alpha=0.79 for ASD items, and alpha=0.70 for dissociation items. Conclusions: Symptoms of ASD are common in the immediate post-injury period for youth who sustain injuries from interpersonal violence. Screening for ASD by ED physicians, during what may be the only medical visit, will help identify those youth at risk for developing PTSD, allowing proper prevention programs to be implemented. The evaluation of the relationship between ASD and PTSD may also help guide ED-generated mental health and community referrals.

Learning Objectives: Participants will be able to: 1) List the key elements of Acute Stress Disorder (ASD) 2) Describe the incidence of ASD in violently injured children and youth 3) Discuss the implications of Emergency Department screening of ASD symptoms for secondary prevention of psychological sequelae of violent injury

Keywords: Violence, Psychological Indicators

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA