International Survey of Hospital Emergency Department Staff Evaluates Psychosocial Care for Injured Children

December 21, 2015

Every year, tens of millions of children around the world sustain injuries that require hospital care. The consequences are not only physical, but also emotional, and can be long-lasting. A new study published today in the Journal of Pediatrics surveyed Emergency Department staff from more than 80 countries and identified knowledge and confidence gaps regarding child traumatic stress and psychosocial care, and a desire for more education.
Approximately one in six injured children develops persistent stress symptoms, such as nightmares, con-centration difficulties and negative thoughts, that impair functioning and development after an injury occurs. Apart from physical care, medical providers can play a key role in supporting injured children from a psychosocial perspective. Through the survey of 2,648 emergency department physicians and nurses, an international research team found several gaps in providing this psychosocial care. 
The survey respondents saw psychosocial care as part of their job, but only half of physicians and nurses knew that toddlers can develop trauma symptoms. Only about 40 percent of respondents recognized that children who behave calmly in the emergency department can still develop persistent stress, which the researchers say is in fact, absolutely possible.
“Staff members told us in a previous study that they learn about emotional support mostly by trial and error, and by watching colleagues. These results show that we need a more systematic approach to teach about the emotional aspects of emergency care, starting at medical and nursing school,” said lead researcher Eva Alisic, PhD.
Seventy-five percent of the staff felt very confident explaining medical procedures to children and parents, while only 14 percent felt equally confident about educating children and families about traumatic stress reactions. Similarly, only a minority of respondents felt very confident explaining to families how to access mental health services. 
“This study, which involved emergency professionals from 87 countries around the world, showed that stress and psychosocial care and education is very much needed and would be welcomed,” said Rachel M Stanley, MD, division chief of Emergency Medicine at Nationwide Children’s and one of the principal investigators for the Center for Pediatric Trauma Research at The Research Institute at Nationwide Children’s. Dr. Stanley was one of three authors from the United States who worked on the study. She represents The Pediatric Emergency Care Applied Research Network and is a member of its steering committee.
“Post-Traumatic Stress Disorder is a problem to some extent for every child involved in a traumatic event, so this work starts to address the issue of education at a big picture level,” said Dr. Stanley.
Ninety-three percent of emergency department staff who responded wished to receive further education on psychosocial care for injured children. Although the study found differences according to length of professional experience and between high, middle and low income countries, these effects were small. 
The survey is the first to assess staff through PERN, the international collaboration of pediatric emergency medicine research networks. 

About Nationwide Children's Hospital

Named to the Top 10 Honor Roll on U.S. News & World Report’s 2019-20 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital is one of America’s largest not-for-profit freestanding pediatric health care systems providing wellness, preventive, diagnostic, treatment and rehabilitative care for infants, children and adolescents, as well as adult patients with congenital disease. Nationwide Children’s has a staff of more than 13,000 providing state-of-the-art pediatric care during more than 1.5 million patient visits annually. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s physicians train the next generation of pediatricians and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded freestanding pediatric research facilities. More information is available at