Heart rate and posttraumatic stress in injured children

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 greater than or equal to 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, 1.1-5.41). 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.