Evaluation of Bedside Caregiver Distress Screening Following Pediatric Hospitalization for Traumatic Injury

Abstract

Youth hospitalized for traumatic injury have high risk of developing mental health concerns. As such, the American College of Surgeons guidelines require trauma centers to provide mental health screening to patients at risk. Evidence-based guidance is needed to inform screening tool selection and implementation. This study evaluated the utility of caregiver self-report on the Peritraumatic Distress Inventory (PDI) at bedside to predict mental health symptoms in caregivers and youth 30 days post-injury, using data collected 2015–2024. Caregivers completed the PDI at hospital bedside and self-reported on distress (Kessler-6) 30 days post-injury (n = 306). Youth self-reported symptoms of PTSD (n = 134) and depression (n = 160) post-injury. At 30 days, 10% of caregivers had clinically elevated distress scores, 34% of youth had elevated depression symptoms, and 37% of youth had elevated PTSD symptoms. Caregivers with elevated PDI at baseline were 8% more likely to have elevated 30-day distress; youth of caregivers with elevated PDI were 6% more likely to have elevated 30-day depression symptoms. Receiver operating characteristic (ROC) curves for the PDI suggested a cut-point of 28 to predict caregiver distress and 21 to predict youth depression symptoms following the acute post-trauma period. The PDI demonstrated low clinical utility for predicting later caregiver distress, but performed well as a screener of youth depressive symptoms. Caregiver self-report on the PDI was predictive of youth depression symptoms 30 days following injury. Including caregiver PDI in mental health screening protocols may improve trauma centers’ ability to address the needs of youth and families after injury.

Implications for Impact Statement

This study suggests that a caregiver screener of distress shortly following pediatric traumatic injury can help identify youth at risk for depression symptoms 30 days after their injury. Assessing caregiver distress within trauma center screening protocols may help better address the mental health needs of injured youth and their families.