신체적 손상을 입은 아동의 외상 후 스트레스 장애증상 관련요인

Abstract

The purpose of this study was to evaluate the relationships among general and physical injury characteristics, depression, anxiety, and posttraumatic stress disorder symptoms (PTSS) in physically injured children. Participants consisted of children 7-12 aged consecutively visited to an emergency department (ED) in J. province following traumatic injury. 131 children and their families agreed to participate in this study, 70 of them responded to interview but 61 refused. There were significant differences in age, type and place of physical injury, operation, pain score between dropouts and participants group. Data were collected form January to November 2013. Procedure of data collection was made up 3 steps. First, for collecting general and physical injury characteristics, children and their families were interviewed and children's medical records were reviewed. Second, children responded to 3 types of questionnaires for assessing depression (Korean version of CDI), anxiety (Korean version of MAS) and PTSS (Korean version of CRTES) at 2 weeks after the trauma (T1). Finally, children answered to same questionnaires at 4 weeks later (T2). SPSS version 18.0 programs for Windows was used for data analysis including descriptive statistics, chi-square test, Fisher's exact test, t-test, ANOVA and Pearson's corelation analysis. The results of this study were as follows: 1. Boys were 70.0% of the children in this study. The mean age of the children was 10.64 years (SD= 2.20), 55% of the children were 10 to 12 years old. 2. Most common type of physical injury was falling down (24.3%) and the second-highest type was laceration (21.4%). Children had injured at road (22.9%), home (21.4%), and school/education facilities (21.4%) and so on. 32 children (45.7%) complained pain, and the mean of their pain score was 53.75(SD=25.62)/100 in ED. Injury severity was measured with the New Injury Severity Scale (NISS), the mean of NISS was 7.49(SD=8.59). Severe group by NISS was 4.3%, moderate group was 38.6%, and mild group was 57.1% of children. 3. The mean of PTSS(T1) and PTSS(T2) were 15.60(SD=16.34) and 8.36(SD=11.29), respectively. There was significant difference (t=-3.95, p<.001) between T1 and T2. Children showed fewer symptoms at T1 than T2. And there were also significant differences between reexperiencing (t=-3.44, p=.001) avoidance/numbing (t=-3.85, p<.001), hyperarousal (t=-2.84, p=.006) at T1 and T2. But there were no differences between levels of depression or anxiety at T1 and T2. 4. There was no difference between boys' and girls' PTSS at T1, but at T2 boys reported significantly higher PTSS than girls (t=1.99, p=.050). Severe injured group reported the highest PTSS at T1 than other groups, but there no difference in PTSS at T2 among them. 5. Systolic and diastolic blood pressure and respiration rate in ED, and level of anxiety at T1 were significantly related to PTSS at T1, respectively. Heart rate, and respiration rate in ED, level of anxiety at T1 and T2 were significantly related PTSS at T2, respectively. The results of the current study are noteworthy given that children's heart rate in ED and PTSS at 2 weeks after trauma were related to PTSS at 4 weeks. Heart rates are easily obtained data at ED, and it do not take a long time to assess PTSS by CRTES-R at 2 weeks after trauma. The limitations of this investigation are relatively small sample size and this sample was not collected randomly, which limits to the extent to generalize these findings. Heart rate was checked once at ED, so these results might reflected children's emotional state which was contingent to the strange surroundings in hospital. Future investigations need to be designed to have sufficient sample size and to examine PTSS at above 4 weeks after trauma. Further studies may ascertain the cutoff range of heart rate in ED for detecting PTSS. Researches for examining the changes of PTSS over time could discover PTSS trajectories in physically injured children. Those results may be used to detect PTSS early, and to provide nursing care for them individually.