Els van Meijel

75 Results of a 2–4-year follow-up study | Chapter 4 physical problems and negative consequences on their education, social life and future plans. Our results revealed a substantial difference between children with and without PTSD regarding permanent physical impairment, indicating an association between the presence of PTSD and permanent physical impairment. Adolescence in combination with permanent impairment may have an influence on later PTSD as this can be a sensitive period in which this age group is modeling future plans. The consequence may be that adolescents are more at risk for long-term negative psychological outcome when permanent physical impairment negatively influences their future plans. Further research, preferably in a larger sample, is needed to test this hypothesis and other possible explanations regarding an association between permanent physical impairment and PTSD. Our results have implications for clinical practice. To prevent long-term negative consequences of accidents, we recommend systematic monitoring—including screening—of injured children and their parents. The introduction of trauma-informed care can facilitate this process. Children with permanent physical impairment or ongoing physical problems may need special attention. For those who need it, we recommend active promotion of timely and appropriate evidence-based trauma- focused psychotherapy. Healthcare professionals should be aware of the importance of children completing their trauma-focused psychotherapy and should find ways to prevent drop-out. Acknowledgements We gratefully acknowledge and thank Joost Daams, clinical librarian, Amsterdam UMC, University of Amsterdam, the Netherlands, for his help with the literature search; Rebecca Holman, clinical statistician at Clinical Research Unit, AmsterdamUMC, University of Amsterdam, the Netherlands for her statistical advice and her help with the interpretation of the data, and Charles Frink, (Frink Communications, Nijmegen, the Netherlands) for his contribution to text editing. This work was carried out as part of the Amsterdam Public Health research institute, Amsterdam, the Netherlands.