Els van Meijel

71 Results of a 2–4-year follow-up study | Chapter 4 These three children still reported high levels of symptoms and were still diagnosed with PTSD at T2. In two of the children the partial PTSD developed into full PTSD between T1 and T2. None of the eight children with self-reported PTSS at T1 received trauma-focused therapy; six children recovered spontaneously and two children still met criteria for self-reported PTSS at T2. Children who no longer fulfilled self-reported PTSS criteria at T2 retrospectively attributed the high score at T1 to stressful circumstances other than the accident. Discussion The prevalence of PTSD at first assessment and at long-term follow-up was 11.6% and 11.4%, respectively. Our findings are consistent with those of Hiller et al. (2016). In their meta-analytic study they reported a prevalence of 11% at 1 year after non-intentional trauma exposure. Compared to children without PTSD or PTSS, children with PTSD or PTSS reported significantly more permanent physical impairment. Our findings indicate that there may be an association between permanent physical impairment and long-term PTSD or PTSS but an association between the other individual factors and PTSD or PTSS is not indicated. Although some of the children in our study recovered fromPTSD following a successful trauma-focused therapy, in other children symptoms developed later on, continued at the initial level, or worsened from partial to full PTSD. Some children developed PTSD following new traumatic events, while still suffering from posttraumatic stress symptoms associated with the accident. The prevalence of PTSD at follow- up demonstrates the importance of being aware of the long-term consequences of accidents. It also indicates that long-termmonitoring of children following accidents is appropriate, in line with the “best practice” following acute trauma, as proposed by the NICE (2005). The NICE guideline recommends “watchful waiting” including screening to identify those at risk who will benefit from further monitoring and timely therapeutic intervention (NICE, 2005). These recommendations could be applied in practice by implementing Trauma-Informed Care (TIC), a multidisciplinary approach to reduce the risk for persisting posttraumatic stress and PTSD after injury (Marsac et