Authors: Brandon G. Rocque, MD, MS, FAANS; Kathrin Zimmerman, BA; Bobby May, BS; Anastasia Arynchyna, MPH; Laura Dreer, PhD; James Johnston, MD; Curtis Rozzelle, MD; Jeffrey Blount, MD (Birmingham, AL)

Pediatric medical care can be stressful for patients and their families. We hypothesize that children with hydrocephalus and their parents are at high risk for treatment-related post-traumatic stress symptoms.

Methods: We administered the Post-Traumatic Stress Disorder (PTSD) Checklist for the DSM-5 (PCL-V) and the Child Stress Disorders Checklist (CSDC) to caregivers of children with hydrocephalus. The PCL-V is a 20-item self-assessment of the severity of PTSD symptoms. The CSDC is a 35-item proxy-report of PTSD symptoms in children. We also administered the Acute Stress Checklist for Kids (ASC-Kids), a 29-item self-report of PTSD symptoms for children above age 7. We extracted clinical and demographic data from medical records (hydrocephalus etiology, shunt infection, race, etc.), testing for association between PTSD scores and clinical variables.

Results: Of 92 caregivers completing the PCL-V, 13 (14%) scored above 33, indicating high likelihood of formal PTSD. Mean score was 17 (range 0-71). PTSS severity was significantly higher in caregivers: of non-white children (p=0.040), without a college degree (p=0.037), and without spouse or partner (p=0.0028). Hydrocephalus was the most common reason given for the presence of these symptoms.
71 caregivers completed the CSDC. Mean score was 5.87 (range 0-30). Children with developmental problems had higher total scores (p<0.01), and PTSD subcategory scores: re-experiencing, avoidance, numbing/dissociation, increased arousal, function impairment (p<0.03 for all).
41 children completed the ASC-Kids. Mean score was 8.85 (range 0-44). There was no correlation between self-perceived traumatic stress and other variables.
While there was poor correlation between caregiver perception of child stress (CSDC) and child self-reported stress (ASC-Kids), there was a positive correlation between ASC-Kids total score and CSDC re-experiencing sub-score (rho=0.40, p=0.026).

Conclusions: Post-traumatic stress symptoms are present and significantly severe in parents of children with hydrocephalus. Children themselves have less severe PTSS. Further research is necessary to understand the implications of these findings on clinical care.