Prevalence of posttraumatic stress disorder in paediatric patients following orthopaedic trauma: A systematic review

Purpose: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may develop after exposure to severe psychological threats. It is characterized by debilitating symptoms such as re-experiencing and negative changes in mood and cognitions which are associated with comorbidity, functional impairment and increased mortality. Although orthopaedic trauma may be classified as a traumatic experience causing PTSD, the prevalence of PTSD in paediatric patients following orthopaedic trauma is currently unknown. Methods: This systematic review aimed to obtain insight into the prevalence of PTSD in paediatric patients after orthopaedic trauma (with or without surgical intervention). Seven medical literature databases were searched to identify studies reporting on the occurrence of PTSD in paediatric patients following orthopaedic trauma. Results: Ten studies were included for analysis. Overall, the pooled prevalence of PTSD was 15% (95% confidence interval: -5.1%, 34.2%), with significant heterogeneity between studies regarding patient population (e.g. age, gender and type of orthopaedic injury) as well as tools used to diagnose PTSD - all influencing the occurrence of PTSD. Conclusions: As PTSD appears to be a relatively common psychological comorbidity after orthopaedic paediatric trauma, we emphasize that both clinicians and parents should be aware of PTSD symptoms in children to allow early treatment of PTSD. Significance of Study: Approximately one in seven children may develop PTSD following orthopaedic trauma, highlighting the importance of systematic screening and monitoring of PTSD symptoms in paediatric patients recovering from orthopaedic injuries. Level of Evidence: Level II (systematic review of level-II studies).