Els van Meijel

115 General discussion | Chapter 7 have a positive screen would be referred for further assessment (van Meijel et al., 2015). Stepped models that link a positive screening result to systematic follow-up are recommended as best practice for prevention of persistent posttraumatic stress symptoms or PTSD after a potentially traumatic event (NICE, 2005; Ward-Begnoche et al., 2006). Reproduction of research findings In our study on the evaluation of the STEPP (van Meijel et al., 2015), we aimed to reproduce research results on the performance of the STEPP (Winston et al., 2003), thus aiding scientific progress in general, and specifically on the international utility of screening instruments. Despite our study, there is still a lack of replication studies for instruments screening for risk after injury (Kassam-Adams, Marsac, Garcia-Espana, & Winston, 2015). Our study also added to the knowledge on the prevalence of PTSD following accidental injury, in the Netherlands and other countries. When we started the study, knowledge on the prevalence of PTSD in specific populations was scarce. The assumption was that up to 37.5% of the children developed PTSD following unintentional or accidental injury. In the last decade, research results—such as those from our study —have shown that this prevalence is probably lower: 8.4 to 13.3% (Alisic et al., 2014; van Meijel et al., 2015). These new figures enable better allocation of mental health resources and improvements in the design of new research projects, especially a more accurate calculation of the power and the sample size of future studies (Alisic et al., 2014). This can benefit studies such as the STEPP study (van Meijel et al., 2015), in which the prevalence of PTSD was lower than expected. Our findings in the light of the model of Pediatric Medical Traumatic Stress (PMTS) The findings of our studies on pain, long-term PTSD and parental PTSS (Chapters 3 to 5) highlight various factors associated with posttraumatic stress following accidental injury. The model of PMTS as introduced in Chapter 1 may help to explain the role of these factors within a broader context. In our study on factors associated with PTSD (Chapter 3), we found that severe acute pain is associated with later PTSD (van Meijel et al., 2019). The PMTS model illustrates that pain can occur during all three phases: from peritrauma to many years after discharge from care. This can be important in understanding the development and