Screening for traumatic stress in children and adolescents with congenital heart disease

Abstract

BackgroundPrevious research has indicated that up to one-third of children undergoing cardiac surgery develop posttraumatic stress disorder (PTSD) following cardiac surgery. Despite the potential long term implications for mental health from this finding, there is no uniform screening procedure for traumatic stress that exists within pediatric cardiac care. ObjectivesA quality improvement initiative was developed to improve standards of care to better identify, manage, and prevent traumatic stress in pediatric cardiology patients. MethodsQuality improvement science methodology was utilized to develop, implement, study, and adopt changes in clinical practice within a pediatric cardiac outpatient clinic. Specifically, children who had undergone cardiac surgery, interventional cardiac catheterization, or heart transplant were offered screening for symptoms of traumatic stress using the Children's Revised Impact of Events Scale. Chi-Square tests and logistic regression were used to analyze differences associated with sociodemographic variables, type of surgical repair, and version of the traumatic stress symptom screener that was utilized. ResultsSuccessful implementation to improve quality of care occurred during a 24-month period as screening of eligible patients for traumatic stress increased from 0 % to 95 %. At risk scores for traumatic stress were found in 14 % of patients who were then subsequently referred to social work for further assessment and triage to mental and behavioral health services. Access to education about traumatic stress increased for patients, parents, and the medical team via the use of informational teaching sheets and increased dialogues among staff. ConclusionA multidisciplinary quality improvement intervention was effective in screening children at risk for traumatic stress who had experienced cardiac surgery, interventional cardiac catheterization, or heart transplant. Administering a screening tool for traumatic stress appears to be an effective means of identifying patients at risk for traumatic stress.