{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T20:45:25Z","timestamp":1777927525266,"version":"3.51.4"},"reference-count":71,"publisher":"SAGE Publications","issue":"15-16","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>Up to 50% of children sustaining physical injury develop post-traumatic stress symptoms (PTSS). Most studies of PTSS have not included patients with traumatic brain injury (TBI); consequently, the influence of injury type and severity on the longitudinal course of PTSS is unclear. To address this gap, we completed a longitudinal prospective cohort study examining the trajectory of self-reported PTSS severity during the first year after TBI or orthopedic injury (OI). Within a biopsychosocial framework, we examined PTSS in relation to injury variables, demographic characteristics, and pre-injury child and family functioning. Patients ages 9\u201315 years with TBI or OI were recruited from two level I pediatric trauma centers. Online surveys were completed as soon as possible following injury (mdn = 8 days). Caregivers rated pre-injury family, sociodemographic, and child characteristics. Follow-up surveys assessing children\u2019s self-reported PTSS using the Children\u2019s PTSD Symptom Scale (CPSS) were scheduled 3,6, and 12 months after injury. English-speaking families completed surveys either online or by telephone interview; Spanish-speaking families were interviewed. Baseline surveys were completed by 303 families; 265 (87%) completed at least 1 follow-up and comprised the cohort. General linear mixed models examined the influence of injury group and severity, age, sex, and time of assessment on CPSS scores. Pre-injury estimates of child and family functioning were examined as predictors in supplemental models. Participants (72% boys, mean [SD] age 12.7 [1.9] years) included 204 with TBI (76 mild, 82 complicated-mild\/moderate, 46 severe) and 61 with OI. Relative to OI, patients with TBI had significantly elevated mean CPSS scores at 3 (3.7 points, 95% confidence intervals [CI]: 1.1, 6.3); 6 (3.2, 95% CI: 0.7, 5.7) and 12 months (2.3, 95% CI: 0.1, 4.5). The primary model indicated that TBI severity had a nonlinear relation with CPSS. Mild TBI (mTBI) had the highest mean scores; with significant differences relative to OI at 3 (4.6 points, 95% CI: 1.6, 7.6); 6 (5.7, 95% CI: 2.7, 8.6) and 12 months (3.2, 95% CI: 0.6, 5.8). This model also revealed that adolescent females had higher CPSS scores than children or adolescent males. Differences relative to younger males at 6 and 12 months were 4.9 (95% CI: 1.6, 8.3) and 5.0 points (95% CI: 2.1, 8.0). In supplemental models, higher symptom burden was associated with poorer baseline family functioning and with higher levels of children\u2019s pre-injury anxiety, affective problems, and conduct problems. PTSS persisted for a significant minority of patients with TBI across the first year of recovery, particularly those with mTBI. Screening should emphasize risk factors to target patients with the greatest need for trauma-focused intervention. Cost-effective, scalable, evidence-based trauma-focused interventions are essential to meet American College of Surgeons standards to provide psychological screening and treatment to children sustaining PTSS.<\/jats:p>","DOI":"10.1089\/neu.2024.0578","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T11:55:23Z","timestamp":1745322923000},"page":"1382-1393","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Trajectory of Post-Traumatic Stress During the First Year after Pediatric Traumatic Brain or Orthopedic Injury"],"prefix":"10.1177","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4544-1013","authenticated-orcid":false,"given":"Linda","family":"Ewing-Cobbs","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Children\u2019s Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Charles S.","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Clark","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather T.","family":"Keenan","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2017.06.003"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2013.2741"},{"key":"e_1_3_8_4_2","unstructured":"Centers for Disease Control and Prevention NCfIPaC. Web-based injury statistics query and reporting system (WISQARS). 2016."},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000152537.15672.B7"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.113.131227"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1037\/neu0000305"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/HTR.0000000000000319"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.12566"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10880-019-09615-5"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/pec.0000000000000595"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsv074"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000508"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534765606294562"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-6155.2008.00141.x"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2011.12.001"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2011.03.001"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsq115"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2008.02.007"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.159.11.1074"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsj056"},{"key":"e_1_3_8_22_2","doi-asserted-by":"publisher","DOI":"10.1207\/s15374424jccp2802_10"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.3109\/02699050903508226"},{"key":"e_1_3_8_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-199810000-00001"},{"key":"e_1_3_8_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-200202000-00009"},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(74)91639-0"},{"key":"e_1_3_8_27_2","doi-asserted-by":"publisher","DOI":"10.1080\/16501960410023859"},{"key":"e_1_3_8_28_2","volume-title":"National Center for Injury Prevention and Control on Mild Traumatic Brain Injury in the US: Steps to Prevent a Serious Public Health Problem","year":"2003","unstructured":"National Center for Injury Prevention and Control on Mild Traumatic Brain Injury in the US: Steps to Prevent a Serious Public Health Problem. Centers for Disease Control and Prevention: Atlanta, GA; 2003."},{"key":"e_1_3_8_29_2","doi-asserted-by":"publisher","DOI":"10.3171\/PED\/2008\/1\/6\/461"},{"key":"e_1_3_8_30_2","volume-title":"Association for the Advancement of Automotive Medicine","author":"Abbreviated injury scale","year":"1990","unstructured":"Abbreviated injury scale. Association for the Advancement of Automotive Medicine. Springer: Des Plaines, IL; 1990."},{"key":"e_1_3_8_31_2","doi-asserted-by":"publisher","DOI":"10.1207\/S15374424JCCP3003_9"},{"key":"e_1_3_8_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2010.02.011"},{"key":"e_1_3_8_33_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1752-0606.1985.tb00028.x"},{"key":"e_1_3_8_34_2","volume-title":"Manual for the Child Behavior Checklist\/4-18 and 1991 Profile","author":"Achenbach T","year":"1991","unstructured":"Achenbach T. Manual for the Child Behavior Checklist\/4-18 and 1991 Profile. University of Vermont College of Medicine: Burlington, VT; 1991."},{"key":"e_1_3_8_35_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.1997.tb01545.x"},{"key":"e_1_3_8_36_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2008.00998.x"},{"key":"e_1_3_8_37_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2020.7541"},{"key":"e_1_3_8_38_2","doi-asserted-by":"publisher","DOI":"10.1080\/15374416.2012.632348"},{"key":"e_1_3_8_39_2","doi-asserted-by":"publisher","DOI":"10.1037\/neu0000299"},{"key":"e_1_3_8_40_2","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.155.5.625"},{"key":"e_1_3_8_41_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617709990671"},{"key":"e_1_3_8_42_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneng.2013.00013"},{"key":"e_1_3_8_43_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.666"},{"key":"e_1_3_8_44_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2016.3470"},{"key":"e_1_3_8_45_2","doi-asserted-by":"publisher","DOI":"10.1097\/HTR.0000000000000043"},{"key":"e_1_3_8_46_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2015.3992"},{"key":"e_1_3_8_47_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-200404000-00006"},{"key":"e_1_3_8_48_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000159247.48547.7D"},{"key":"e_1_3_8_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpsycho.2017.09.010"},{"key":"e_1_3_8_50_2","doi-asserted-by":"publisher","DOI":"10.1007\/7854_2009_9"},{"key":"e_1_3_8_51_2","doi-asserted-by":"publisher","DOI":"10.1017\/s0033291714001901"},{"key":"e_1_3_8_52_2","doi-asserted-by":"publisher","DOI":"10.1177\/00368504221135469"},{"key":"e_1_3_8_53_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/24.4.335"},{"key":"e_1_3_8_54_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsp050"},{"key":"e_1_3_8_55_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2016.4842"},{"key":"e_1_3_8_56_2","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2012.656789"},{"key":"e_1_3_8_57_2","doi-asserted-by":"publisher","DOI":"10.1002\/jts.21704"},{"key":"e_1_3_8_58_2","doi-asserted-by":"publisher","DOI":"10.1002\/jts.22864"},{"key":"e_1_3_8_59_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsad067"},{"key":"e_1_3_8_60_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10567-014-0174-2"},{"key":"e_1_3_8_61_2","doi-asserted-by":"publisher","DOI":"10.1037\/cpp0000261"},{"key":"e_1_3_8_62_2","doi-asserted-by":"publisher","DOI":"10.1037\/tra0001795"},{"key":"e_1_3_8_63_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-023-07806-y"},{"key":"e_1_3_8_64_2","doi-asserted-by":"publisher","DOI":"10.1006\/nimg.1999.0466"},{"key":"e_1_3_8_65_2","doi-asserted-by":"publisher","DOI":"10.1002\/jts.20640"},{"key":"e_1_3_8_66_2","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.13193"},{"key":"e_1_3_8_67_2","doi-asserted-by":"publisher","DOI":"10.1080\/02699050500110165"},{"key":"e_1_3_8_68_2","doi-asserted-by":"publisher","DOI":"10.1080\/02699052.2016.1201592"},{"key":"e_1_3_8_69_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10567-012-0124-9"},{"key":"e_1_3_8_70_2","unstructured":"American College of Surgeons. Best Practice Guidelines: Screening and Intervention for Mental Health Disorders and Substance Use and Misuse in the Acute Trauma Patient. 2023."},{"key":"e_1_3_8_71_2","doi-asserted-by":"publisher","DOI":"10.1037\/tra0000116"},{"key":"e_1_3_8_72_2","doi-asserted-by":"publisher","DOI":"10.3389\/fresc.2022.1085967"}],"container-title":["Journal of Neurotrauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/neu.2024.0578","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/neu.2024.0578","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/neu.2024.0578","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:46:13Z","timestamp":1777675573000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/neu.2024.0578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":71,"journal-issue":{"issue":"15-16","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1089\/neu.2024.0578"],"URL":"https:\/\/doi.org\/10.1089\/neu.2024.0578","relation":{},"ISSN":["0897-7151","1557-9042"],"issn-type":[{"value":"0897-7151","type":"print"},{"value":"1557-9042","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}