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Nancy Kassam-Adams, PhD; J. Felipe Garcia-España, PhD; Joel A. Fein, MD; Flaura Koplin Winston, MD, PhD

Arch Gen Psychiatry. 2005;62:335-340.

Background  Elevated, acute heart rate has been related to later posttraumatic stress disorder (PTSD) development in injured adults, but this has not been examined in children and adolescents. Better understanding of the relationship between acute physiological arousal and later child PTSD could help elucidate the etiology of posttrauma responses in children and might identify useful markers for PTSD risk.

Objective  To evaluate the relationship between heart rate assessed in the emergency department (ED) during normal clinical care and later PTSD outcome in traumatically injured children.

Design  Prospective cohort study assessed heart rate at ED triage and PTSD an average of 6 months’ postinjury.

Setting  Large, urban pediatric academic medical center in the northeastern United States.

Participants  One hundred ninety children and adolescents (aged 8-17 years) hospitalized for traffic-related injury.

Main Outcome Measure  Clinician-Administered PTSD Scale for Children and Adolescents.

Results  The group of children who developed partial or full PTSD had a higher mean ± SD heart rate at ED triage than those who did not go on to have PTSD (109.6 ± 22.3 vs 99.7 ± 18.0 beats per minute). Children with an elevated heart rate (defined as 2 SDs higher than the normal resting heart rate for their age and sex) at ED triage were more likely to meet criteria for partial or full PTSD at follow-up, even after adjusting for age, sex, and injury (adjusted odds ratio, 2.4 [95% confidence interval, 1.1-5.4]).

Conclusion  These results suggest an association between early physiological arousal and the development or persistence of PTSD symptoms in injured children and point to the importance of better understanding the interplay between physiological and psychological functioning after a traumatic stressor.

Author Affiliations: TraumaLink: The Pediatric Interdisciplinary Injury Control Research Center (Drs Kassam-Adams, Garcia-España, Fein, and Winston), Center for Pediatric Traumatic Stress, Department of Psychology (Drs Kassam-Adams, Fein, and Winston), Division of Biostatistics (Dr Garcia-España), The Children’s Hospital of Philadelphia, Divisions of Emergency Medicine (Dr Fein), and General Pediatrics (Dr Winston), Department of Pediatrics, the University of Pennsylvania School of Medicine, Philadelphia.

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