{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:16:37Z","timestamp":1791875797381,"version":"4.3.4"},"reference-count":34,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,6]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Paediatric major trauma patients with more severe injuries and physiological or biochemical abnormalities as a result of the injury are more likely to require invasive management in the form of an operation\/interventional radiology (IR). Adverse psychological outcomes, such as post-traumatic stress disorder, anxiety, depression and adjustment disorder, are frequently observed in paediatric patients with major trauma. Similarly, it is recognised that children and adolescents who have invasive management are also at an increased risk of adverse psychological outcomes. However, it is not known to what extent major trauma patients requiring invasive management are at risk of adverse psychological outcomes compared with those managed conservatively. This study aims to determine whether paediatric major trauma patients who require an operation\/IR have increased odds of having an adverse psychological outcome compared with those who are managed conservatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines will be used to construct this review. The databases Medline (via Ovid), Embase (via Ovid), PsycInfo (via Ebscohost) and Cinahl (via Ebscohost) will be searched from inception to February 2025. Both title and abstract screening and full-text screening will be done by two reviewers, with an adjudicating third reviewer. For randomised controlled trials, the Cochrane Risk of Bias Tool will be employed, while for non-randomised studies, the Newcastle-Ottawa Quality Assessment Scale will be used. We will assess bias using contoured funnel plots (with p set at 0.01, 0.05 and 0.10), non-parametric trim-fill analysis, leave-one-out analysis and Galbraith plotting. We will execute formal (Egger) testing for funnel plot asymmetry and also calculate prediction intervals if sufficient study N of 10 is accrued. Certainty and confidence in cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical review is not required as no original data will be collected. Results will be disseminated through peer-reviewed publications and at academic conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42025643459.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101971","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T15:15:52Z","timestamp":1755616552000},"page":"e101971","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Psychological outcomes in paediatric major trauma patients who require invasive management: protocol for a systematic review and meta-analysis"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3839-1874","authenticated-orcid":false,"given":"Owen","family":"Hibberd","sequence":"first","affiliation":[{"name":"Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, Cambridge University, Cambridge, UK"},{"name":"Blizard Institute, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline E","family":"Thomas","sequence":"additional","affiliation":[{"name":"Georgetown University, Washington, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Gentle","sequence":"additional","affiliation":[{"name":"Blizard Institute, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2607-9954","authenticated-orcid":false,"given":"Sandi","family":"Angus","sequence":"additional","affiliation":[{"name":"Blizard Institute, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyridon","family":"Karageorgos","sequence":"additional","affiliation":[{"name":"Blizard Institute, Queen Mary University of London, London, UK"},{"name":"National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4383-9434","authenticated-orcid":false,"given":"Veronica","family":"Phillips","sequence":"additional","affiliation":[{"name":"University of Cambridge Medical Library, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen H","family":"Thomas","sequence":"additional","affiliation":[{"name":"Blizard Institute, Queen Mary University of London, London, UK"},{"name":"Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"2025123106470384000_15.8.e101971.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2201761"},{"key":"2025123106470384000_15.8.e101971.2","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-315636"},{"key":"2025123106470384000_15.8.e101971.3","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.009817"},{"key":"2025123106470384000_15.8.e101971.4","article-title":"Association of Non-Transfusion-Related Admission Hypocalcaemia With Haemodynamic Instability in Paediatric Major Trauma: A Retrospective Single-Centre Pilot Study","volume":"16","author":"Hibberd","year":"2024","journal-title":"Cureus"},{"key":"2025123106470384000_15.8.e101971.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-017-4396-6"},{"key":"2025123106470384000_15.8.e101971.6","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1007\/s10140-022-02067-9","article-title":"Pediatric trauma and the role of the interventional radiologist","volume":"29","author":"Annam","year":"2022","journal-title":"Emerg Radiol"},{"key":"2025123106470384000_15.8.e101971.7","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2022-000946","article-title":"Examining the incidence of acute stress in pediatric trauma patients","volume":"7","author":"Schauss","year":"2022","journal-title":"Trauma Surg Acute Care Open"},{"key":"2025123106470384000_15.8.e101971.8","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1177\/0009922819890004","article-title":"Pediatric Integrated Care Models: A Systematic Review","volume":"59","author":"Burkhart","year":"2020","journal-title":"Clin Pediatr (Phila)"},{"key":"2025123106470384000_15.8.e101971.9","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1177\/000313481708301137","article-title":"Continuing Trauma: The Unmet Needs of Trauma Patients in the Postacute Care Setting","volume":"83","author":"Fakhry","year":"2017","journal-title":"Am Surg"},{"key":"2025123106470384000_15.8.e101971.10","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.jss.2020.09.023","article-title":"Post-Traumatic Stress Disorder in Adult and Pediatric Trauma Populations: A Literature Review","volume":"259","author":"Meneses","year":"2021","journal-title":"J Surg Res"},{"key":"2025123106470384000_15.8.e101971.11","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jpedsurg.2021.09.049","article-title":"Mental health outcomes in pediatric trauma patients: A 10 year real world analysis using a large database approach","volume":"57","author":"Chandler","year":"2022","journal-title":"J Pediatr Surg"},{"key":"2025123106470384000_15.8.e101971.12","first-page":"1560","article-title":"Prevalence of posttraumatic stress disorder and major depression after trauma center hospitalization","volume":"69","author":"Shih","year":"2010","journal-title":"J Trauma"},{"key":"2025123106470384000_15.8.e101971.13","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1097\/TA.0000000000001992","article-title":"Prevalence and treatment of depression and posttraumatic stress disorder among trauma patients with non-neurological injuries","volume":"85","author":"Bell","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2025123106470384000_15.8.e101971.14","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1111\/jcpp.13240","article-title":"Prevalence and predictive value of ICD-11 post-traumatic stress disorder and Complex PTSD diagnoses in children and adolescents exposed to a single-event trauma","volume":"62","author":"Elliott","year":"2021","journal-title":"J Child Psychol Psychiatry"},{"key":"2025123106470384000_15.8.e101971.15","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/PCC.0000000000001096","article-title":"Systematic Review of Interventions to Reduce Psychiatric Morbidity in Parents and Children After PICU Admissions","volume":"18","author":"Baker","year":"2017","journal-title":"Pediatr Crit Care Med"},{"key":"2025123106470384000_15.8.e101971.16","doi-asserted-by":"crossref","first-page":"e531","DOI":"10.1097\/PCC.0000000000003696","article-title":"Systematic Review and Meta-Analysis of Prevalence and Population-Level Factors Contributing to Posttraumatic Stress Disorder in Pediatric Intensive Care Survivors","volume":"26","author":"Hay","year":"2025","journal-title":"Pediatr Crit Care Med"},{"key":"2025123106470384000_15.8.e101971.17","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1007\/s40653-021-00391-9","article-title":"Pediatric Medical Traumatic Stress (PMTS) following Surgery in Childhood and Adolescence: a Systematic Review","volume":"15","author":"Stanzel","year":"2022","journal-title":"J Child Adolesc Trauma"},{"key":"2025123106470384000_15.8.e101971.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2021-001147","article-title":"Prevalence of traumatic psychological stress reactions in children and parents following paediatric surgery: a systematic review and meta-analysis","volume":"5","author":"Turgoose","year":"2021","journal-title":"BMJ Paediatr Open"},{"key":"2025123106470384000_15.8.e101971.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2016.01.021"},{"key":"2025123106470384000_15.8.e101971.20","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-020-01542-z"},{"key":"2025123106470384000_15.8.e101971.21","unstructured":"EndNote [program]. Endnote X9 version. Philadelphia, PA Clarivate; 2013."},{"key":"2025123106470384000_15.8.e101971.22","doi-asserted-by":"publisher","DOI":"10.3163\/1536-5050.104.3.014"},{"key":"2025123106470384000_15.8.e101971.23","unstructured":"Health . CAfDaTi. Grey matters: a practical tool for searching health-related grey literature. 2011. Available: https:\/\/www.cadth.ca\/resources\/finding-evidence\/grey-matters"},{"key":"2025123106470384000_15.8.e101971.24","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"2025123106470384000_15.8.e101971.25","unstructured":"Lefebvre CG , Briscoe J , Featherstone S , et al . Chapter 4: searching for and selecting studies. In: Higgins JTJ , ed. Cochrane handbook for systematic reviews of interventions, version 65. Cochrane, 2024."},{"key":"2025123106470384000_15.8.e101971.26","unstructured":"Microsoft . Microsoft excel for mac. 2023."},{"key":"2025123106470384000_15.8.e101971.27","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197403000-00001"},{"key":"2025123106470384000_15.8.e101971.28","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2025123106470384000_15.8.e101971.29","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z"},{"key":"2025123106470384000_15.8.e101971.30","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000015987","article-title":"The trim-and-fill method for publication bias: practical guidelines and recommendations based on a large database of meta-analyses","volume":"98","author":"Shi","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"2025123106470384000_15.8.e101971.31","doi-asserted-by":"crossref","unstructured":"Page MJ , Higgins JP , Sterne JA , et al . Assessing risk of bias due to missing results in a synthesis. In: Higgins JTJ , ed. Cochrane handbook for systematic reviews of interventions, version 65. Cochrane, 2024: 349\u201374.","DOI":"10.1002\/9781119536604.ch13"},{"key":"2025123106470384000_15.8.e101971.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2020.09.018"},{"key":"2025123106470384000_15.8.e101971.33","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2025123106470384000_15.8.e101971.34","doi-asserted-by":"crossref","unstructured":"Takwoingi Y , Dendukuri N , Schiller I , et al . Undertaking meta-analysis. In: Cochrane handbook for systematic reviews of diagnostic test accuracy. 2023: 249\u2013325.","DOI":"10.1002\/9781119756194.ch10"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-101971","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:48:45Z","timestamp":1767192525000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-101971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,19]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bmjopen-2025-101971"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-101971","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}