STTR: An eHealth Solution for Posttraumatic Stress and Pain Screening Integrated in Pediatric Injury Care

ABSTRACT (draft) Each year, 20 million US children are injured, affecting the child, his/her family, and society, which often bears the cost. Among school-age children age 8 to 12, injuries lead to 40,000-50,000 hospital admissions annually, resulting in millions of dollars of medical and work loss costs. After hospital discharge, many injured children experience pain that is not well-controlled, and approximately 1 in 6 develops posttraumatic stress symptoms (PTSS) that persist for months and interfere with recovery. Although both pain and PTSS have been shown to be associated with health and functional outcomes following injury, few health systems are able to assess these in injured pediatric patients once they are discharged home, hampering follow-up care and impairing optimal outcomes. This project addresses this critical, systemic problem via a novel eHealth approach: delivering validated screening measures via a mobile / online game-based interface to identify child self-reported pain, PTSS, and problems with functional recovery in the post-discharge period, and connect screening results to parents, providers and insurers to optimize follow-up care of injured children. We propose an integrated screening and intervention system that takes advantage of advances in e-Health and developmentally-appropriate engagement strategies, as well as a shifting economic landscape that provides health systems with incentives for optimizing short- and long-term patient outcomes and for meaningful use of health information technology. Building on findings from our Phase I project, we will develop a production-grade system and evaluate its validity and utility in identifying key clinical outcomes identified by stakeholders. With the active involvement of a large regional insurer, we will prepare for commercialization of the system. The project will also explore potential expansion of the system for children with chronic illness.