Persistence of posttraumatic stress in violently injured youth seen in the emergency department

Objective: To determine if symptoms of posttraumatic stress, initially evaluated in the emergency department (ED) setting, persist over time. Design: Prospective cohort study. Setting: Two urban, academic medical center EDs. Patients: Sixty-nine injured patients, aged 12 to 24 years, were assessed for acute posttraumatic stress symptoms at the time of their enrollment in an ongoing ED-based study of intentional youth violence, and assessed for posttraumatic stress symptoms up to 5 months later. Main Outcome Measures: The Immediate Stress Reaction Checklist, administered during the ED visit, and the Symptom Checklist of the Child and Adolescent Trauma Survey, administered during routine telephone follow-up. Results: Patients in the emergency department reported a range of acute stress symptoms on the Immediate Stress Reaction Checklist, with 25% reporting clinically significant distress. On follow-up assessment, 15% reported significant posttraumatic stress symptoms. The severity of acute stress symptoms was strongly associated with the severity of posttraumatic stress symptoms at follow-up (r=0.55, P<.005). Age, sex, injury type, and time from injury to follow-up were not associated with the degree of acute stress or posttraumatic stress symptom severity at initial or follow-up assessment. Conclusion: This study provides preliminary evidence that acute stress symptoms, assessed in the ED in the immediate aftermath of a traumatic injury, are useful indicators of risk for later posttraumatic stress.