WILMINGTON, Del. (May 7, 2025) — Children who experience injuries face higher than average risk of mental health difficulties such as post-traumatic stress disorder and depression. A new study led by a Nemours Children’s Health researcher finds that use of a universal screening tool increased appropriate mental health referrals, and provides guidance on how clinicians in pediatric trauma centers should screen patients for such mental health conditions.
“While the vast majority of children and families describe an immediate increased level of emotional distress after pediatric injury, most recover well over a few weeks to a month. However, a small but important portion of children with injuries and their families experience significant symptoms of post-traumatic stress disorder or other mental health conditions that last for months or longer and interfere with their lives,” said the study’s lead author, Julia Price, PhD, Pediatric Psychologist with Nemours Children’s Health, Delaware Valley. “It is critical to identify families who are at risk of lasting mental health symptoms so that we can offer additional support to them.”
In 2022, the American College of Surgeons (ACS) issued a set of updated standards that required mental health screening and protocols for referring at-risk patients to mental health providers in Level I and Level II trauma centers. In the study recently published in The Journal of Trauma and Acute Care Surgery, Price and a team of researchers from Nemours Children’s Hospital, Children’s Hospital of Philadelphia, the Pediatric Trauma Society, the Society for Trauma Nurses, and the Center for Pediatric Traumatic Stress examined published studies to evaluate the prevalence and types of screening taking place since the guidelines were established.
Key findings:
- Without universal use of a screening tool, patients who could benefit from mental health referrals are sometimes missed. For example, one study showed that when all patients were screened through a universal protocol, appropriate referrals to psychology increased by 40%.
- Studies indicated that centers with universal screening were more effective in directing families to necessary resources than those that relied on physician intuition.
- Effective, brief screening tools that identify which children with injuries are at risk for current and/or future post-traumatic stress symptoms exist and should be used to meet the ACS guideline.
“We strongly recommend universal mental health screening among children with injuries,” Price said. “The benefits, such as timely access to mental health professionals and lower patient distress, greatly outweigh any potential drawbacks, such as the potential discomfort of answering screening questions.”
Price and colleagues recommend that trauma centers use screening tools that have been validated in a medical setting and are proven to detect psychological stress or predict ongoing distress, and avoid tools that have been proven less effective. The tools must also be feasible for use in the emergency department or inpatient setting.
The authors noted that most screening tools in the review were easy to employ, and healthcare workers including nurses, physicians, and social workers could employ them after brief training.
“Identifying traumatic stress in children with injuries is important to their overall recovery and long-term health,” said contributing author Caitlin Axtmayer, LSW, MPH, Program Coordinator at the Center for Pediatric Traumatic Stress at Children’s Hospital of Philadelphia. “This paper supports recent efforts to improve the access to mental health support for children seen in trauma centers.”
On May 9, Price will discuss the paper at a webinar hosted by the Pediatric Trauma Society.
About Nemours Children's Health
Nemours Children’s Health is one of the nation’s largest multistate pediatric health systems, which includes two freestanding children's hospitals and a network of more than 70 primary and specialty care practices. Nemours Children's seeks to transform the health of children by adopting a holistic health model that utilizes innovative, safe, and high-quality care, while also addressing children’s needs well beyond medicine. In producing the highly acclaimed, award-winning pediatric medicine podcast Well Beyond Medicine, Nemours underscores that commitment by featuring the people, programs and partnerships addressing whole child health. Nemours Children's also powers the world’s most-visited website for information on the health of children and teens, Nemours KidsHealth.org.
The Nemours Foundation, established through the legacy and philanthropy of Alfred I. duPont, provides pediatric clinical care, research, education, advocacy, and prevention programs to the children, families and communities it serves. For more information, visit Nemours.org.
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