Emergency department evaluation of acute stress disorder symptoms in violently injured youths

Study objective: We assess the feasibility of evaluating acute Stress disor der (ASD) symptoms in the emergency department and provide an initial estim ate of the prevalence, severity, and variability of these symptoms in viole ntly injured urban children and young adults. Methods: The Immediate Stress Response Checklist (ISRC) was administered-to violently injured patients between the ages of 8 and 24 years who presente d to 2 urban, academic medical center EDs during a 10-week period. The ISRC is designed to assess ASD symptoms in children and youths immediately afte r a traumatic event. Responses are described using summed symptom severity scores and counts of symptoms. Results: Out of 109 identified youths, 81 participated. Fear, helplessness, or horror during the injury event was reported by 59 (73%) of study partic ipants. Each of the following categories of ASD symptoms was reported by a significant number of youths: peritrauma dissociation, 63 (78%); posttrauma dissociation, 33 (41%); re-experiencing intrusive thoughts or images, 66 ( 82%); avoidance, 53 (65%); and hyperarousal, 32 (39%). The ISRC demonstrate d high internal consistency (Cronbach alpha=.88) in this cohort. Conclusion: The ISRC can be used to assess acute-stress reactions in violen tly injured youths in the immediate period after injury. Although these rea ctions appear to be common, there is substantial variability among distinct symptom categories. These results support the need for further investigati on of the relationship between immediate stress responses and longer-term e motional impact of violent injury. Clinicians should consider assessing the emotional responses of children and adolescents who are injured by interpe rsonal violence, even when these injuries seem minor.