Els van Meijel

41 Acute pain and posttraumatic stress symptoms | Chapter 3 Introduction Every year, many children and adolescents (both groups are referred to as “children” in our study) are injured in accidents and they are often treated in the trauma resuscitation room (trauma room) of the Emergency Department. In a trauma room, a multidisciplinary team of medical specialists and nurses take care of the initial assessment and treatment of trauma patients. Patients are referred to the trauma room in cases with a high-energy trauma mechanism involving a risk of severe and/ or potentially life-threatening injuries. A high-energy trauma mechanism refers to mechanisms of injury associated with a high-energy impact such as a fall from height (> 10 ft or 2 to 3 times the height of the child) or a high-risk automobile crash or a pedestrian/bicycle versus automobile collision (American College of Surgeons, 2012). The accident itself, the injury, the pain and medical procedures can all be frightening and potentially traumatic (Kahana et al., 2006; Price et al., 2016). As a result, children may develop acute stress symptoms. These symptoms disappear spontaneously in the majority of the children in the weeks following traumatic events, but 8–14% develop posttraumatic stress disorder (PTSD) following unintentional injury (Alisic et al., 2014; van Meijel et al., 2015) and up to 18% develop severe posttraumatic stress symptoms (PTSS) (Landolt et al., 2005). According to the DSM-5 classification, PTSD includes symptoms of re-experiencing, avoidance, negative alterations in cognitions andmood and increased arousal, resulting in substantial distress or impairment in functioning (APA, 2013). Acute Stress Disorder (ASD) can be diagnosed if symptoms persist for no longer than 1 month after the traumatic event; PTSD can be diagnosed if symptoms persist for longer than 1 month (APA, 2013). PTSD is a debilitating psychiatric disorder, often involving the development of co-morbid disorders (Stallard et al., 2004) and affecting children’s functioning and physical recovery from injury (Kahana et al., 2006). Since ASD or PTSD at a subsyndromal level can also result in substantial impairment in functioning, it is appropriate to also evaluate and treat children reporting clinically significant persistent PTSS (Gold et al., 2008). Most injured patients experience pain, either as a direct consequence of the accident or later on from medical diagnostics and treatment (Baxt, Kassam-Adams, Nance, Vivarelli-O’neill, & Winston, 2004; Keene, Rea, & Aldington, 2011; Melby, McBride, & McAfee, 2011). In a study examining the relationship between acute pain and PTSS in children 8–17 years following traffic-related injury, acute pain was a predictor of PTSS