Screening After Pediatric Injury | Patient Centered Care and Trauma Informed Care for Pediatric Patients

Looking for recommended screening tools for pediatric patients in your Trauma Center? Click here.

What are the current guidelines for Trauma Centers?

The American College of Surgeons (ACS) recognizes the importance integrating attention to psychological and emotional consequences of injury within pediatric trauma care.

In 2018 the ACS recommended that trauma centers implement PTSD screening / referral protocols for injured children, using evidence-based screening tools integrated in electronic health records, and that centers also attend to the emotional consequences of pediatric injury for parents / caregivers.

The current (2022) ACS standards for verification and review of trauma centers, Resources for Optimal Care of the Injured Patient (section 5.29) state that trauma centers must have:

a structured mental health screening and referral protocol [Level I and II centers], or
a clear mental health referral process [Level III centers].

ACS TQP Best Practices Guidelines for mental health in acute trauma patients (2022) address post-injury PTSD and depression screening in children (p. 34), recommending that centers select brief screening tools validated for screening in acutely injured patients.

What other evidence is available about screening?

Building on the ACS guidelines, from 2022-2024 CPTS partnered with the Pediatric Trauma Society (PTS) and the Society for Trauma Nurses (STN) in a formal evidence review process to develop GRADE-based practice management guidelines regarding mental health screening in pediatric injury patients. This was recently published and is available open access in the Journal of Trauma and Acute Care Surgery.

Price, Julia PhD; Marsac, Meghan L. PhD; Ridings, Leigh E. PhD; Axtmayer, Caitlin H. LSW, MPH; James, Richard MLS, MBE; Stroud, Melanie MBA, RN; Durand, Maria Bautista MSN, APRN, FNP-C, CPNP-PC; Longshore, Shannon W. MD; Freeman, Jennifer J. MD; Nickoles, Todd MBA, BSN, RN; Mitchell, Ian MD, MBA; Yang, Chia-Lun PhD; Kassam-Adams, Nancy PhD. Screening for mental health symptoms following pediatric traumatic injury: A practice management guideline (from the Pediatric Trauma Society, Society of Trauma Nurses, and Center for Pediatric Traumatic Stress). Journal of Trauma and Acute Care Surgery ():10.1097/TA.0000000000004578, March 24, 2025. | DOI: 10.1097/TA.0000000000004578

Who, when, and how do we screen?

Screening for traumatic stress within pediatric injury care

Who: All patients with pediatric injury, their parents / caregivers and siblings.
Equity in care -Universal screening for PTSD symptoms ensures all pediatric patients and their families receive the level of support they need.
When: During initial hospital admission or emergency department visit.
How: Select a brief, evidence-based tool validated for this purpose (see below).

Based on the current evidence, the Center for Pediatric Traumatic Stress recommends choosing one of the brief tools below* for screening for traumatic stress in injured patients and their parents / caregivers.

*Other tools, including the Screening Tool for Early Predictors of PTSD (STEPP), do not have current strong evidence supporting their validity for this purpose.

Brief, evidence-based screening tools for acute traumatic stress reactions in children or teens

Acute Stress Checklist for Children (ASC-Kids)

Purpose & Description: Evaluate acute stress reactions in children or teens. Available as 3- or 6-item brief screener, or 29-item full-length checklist.

Validated for: Screening for acute traumatic stress reactions and for risk of persistent traumatic stress in injured children age 8 to 17.

Language: English, Spanish

Who can administer: Any member of the healthcare team; Child can complete as self-report.

Time to administer: 1-2 mins (brief screen versions); 5-10 mins (full version)

When to administer: Any time within 1st month after injury. (In validation studies, the ASC-Kids was administered as early as the day after injury.)

Key reference: Kassam-Adams et al., 2016

Get a copy of the measure.

ASC-Kids English and Spanish with scoring info - all versions.pdf (391 KB)

Child Trauma Screening Questionnaire (CTSQ)

Purpose & Description: 10 item screening tool. Helps identify recently injured children at higher risk for later PTSD.

Validated for: Screening for risk of persistent traumatic stress in recently injured children age 6 to 16.

Language: English

Who can administer: Any member of the healthcare team. Child can complete as self-report.

Time to administer: 2-3 mins

Key reference: Kenardy et al., 2006.

Get a copy of the measure.

Child-Trauma-Screening-Questionnaire-information.pdf (120.61 KB)

For more information on the CTSQ, contact: Justin Kenardy, University of Queensland.

Brief evidence-based screening tools for traumatic stress in older teens and adults

Acute Stress Disorder Scale (ASDS)

Purpose & Description: 19-item self-report checklist assesses acute traumatic stress reactions in adults (or older teens).

Validated for: Screening for acute traumatic stress reactions in adults.

Language: English

Who can administer: Any member of the healthcare team; Adult or teen can complete as self-report.

Time to administer: 5-10 mins

Key reference: Bryant et al., 2000

Get a copy of the measure.

NOTE: CPTS has created an adapted version of the ASDS suitable for use with healthcare staff in the COVID19 pandemic.

Get a copy of the adapted ASDS measure.

ASDS adapted for COVID.pdf (121.46 KB)

PTSD Checklist for DSM5 (PCL-5) (S) (A)

Purpose & Description: 20-item self-report checklist assesses PTSD symptoms in adults (or older teens).

Validated for: Assessing PTSD symptoms in adults.

Language: English, Spanish

Who can administer: Any member of the healthcare team; Adult can complete as self-report.

Time to administer: 5-10 mins

Key reference: Blevins et al., 2015.

Scale available from the National Center for PTSD.

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