Els van Meijel

129 Summary | Chapter 8 Acute pain and later PTSD In addition to factors included in the STEPP screening instrument, we examined to which extent acute pain contributes to later posttraumatic stress. Chapter 3 provided the results of this prospective cohort study. Participants were 135 children, 8-18 years old. We examined the association between acute pain from accidental injury and PTSS in children, taking into account factors potentially related to pain or posttraumatic stress. Within two weeks of the accident we measured the worst experienced pain since the accident took place with a visual analogue scale. Three months after the accident, posttraumatic stress was assessed with a self-report measure. In the total group we found a positive association between acute pain and posttraumatic stress. The amount of pain was negatively associated with injury severity in girls and positively associated with the presence of an extremity fracture in boys. In children who reported severe pain, this pain was significantly associated with PTSS and may account for around 10%of the variance in the severity of posttraumatic stress symptoms. Although the experience of pain is subjective, our study indicates that severe pain is associated with the severity of later posttraumatic stress symptoms. Timely management of pain according to acute pain protocols in all phases and disciplines after accidental injury is therefore recommended. In addition to medication, psychological strategies can be of great help in pain relief. They can be used in accordance with the situation and the child’s characteristics and preferences. Examples of psychological strategies are distraction, paying attention to the child’s fear, explanation of medical routine, reassurance, and encouraging parents’ involvement. Long-term consequences of accidents in children: the follow-up study Chapter 4 provided the results of the 2–4-year follow-up study. Although the long- term impact of traumatic events can be substantial, research on the long-term psychological consequences of accidental injury is scarce. We assessed diagnosed PTSD and clinically significant self-reported posttraumatic stress symptoms (PTSS) in 90 children (11-22 years of age, 60%boys and 40%girls) at 2–4 years after their accident. The outcome was compared to the first assessment 3 months after the accident in 147 children, 8-18 years of age. The prevalence of PTSD was 11.6% at first assessment and 11.4% at follow-up. Our results revealed a substantial difference between children with andwithout PTSD regarding permanent physical impairment, indicating an association between the presence of PTSD and permanent physical impairment. In this study we