Objective This study tested theoretical models of the relationship between pain and posttraumatic stress disorder (PTSD) in children with traumatic brain injury (TBI). Methods Participants consisted of 195 children aged 6–15 years presenting to 1 of 3 Australian hospitals following a mild–severe TBI. Children were assessed at 3, 6, and 18 months after their accident for PTSD (via the Clinician-Administered PTSD Scale for Children and Adolescents [CAPS-CA] clinical interview) as well as physical pain (via the Child Health Questionnaire, 50-item version [CHQ-PF50]). Trained clinicians administered the CAPS-CA at home visits, and the CHQ-PF50 was collected through questionnaires. Results Structural equation modeling found the data supported the mutual maintenance model and also the nested perpetual avoidance model. Conclusions Both models indicate PTSD is driving the presence of pain, and not vice versa. A fourth model stating this was proposed. Therefore, it may be useful to address PTSD symptoms in treating child pain for expediting recovery.

Delirium is a common and serious neuropsychiatric complication in critically ill patients of all ages. In the context of critical illness, delirium may emerge as a result of a cascade of underlying pathophysiologic mechanisms and signals organ failure of the brain. Awareness of the clinical importance of delirium in adults is growing as emerging research demonstrates that delirium represents a serious medical problem with significant sequelae. However, our understanding of delirium in children lags significantly behind the adult literature. In particular, our knowledge of how to assess delirium is complicated by challenges in recognizing symptoms of delirium in pediatric patients especially in critical and intensive care settings, and our understanding of its impact on acute and long-term functioning remains in its infancy. This paper focuses on (a) the challenges associated with assessing delirium in critically ill children, (b) the current literature on the outcomes of delirium including morbidity following discharge from PICU, and care-giver well-being, and (c) the importance of assessment in determining impact of delirium on outcome. Current evidence suggests that delirium is a diagnostic challenge for clinicians and may play a detrimental role in a child’s recovery after discharge from the pediatric intensive care unit (PICU). Recommendations are proposed for how our knowledge and assessment of delirium in children could be improved.

Objectives: This study explored the diagnosis of posttraumatic stress disorder (PTSD) in children and adolescents following pediatric intensive care unit (PICU) admission. Specifically, the study aimed to describe the presentation and prevalence of PTSD symptoms 6 months postdischarge, explore the validity of the DSM-IV PTSD algorithm and alternative PTSD algorithm (PTSD-AA) in school-aged children and adolescents, and examine the diagnostic utility of Criterion C3 (inability to recall aspects of a trauma) in this cohort. Methods: Participants were 59 children aged 6–16, admitted to PICU for at least 8 hours. PTSD was assessed via diagnostic interview (Children's PTSD Inventory) 6 months following PICU discharge. Results: The PTSD-AA was found to provide the most valid measure of PTSD at 6 months. Removing Criterion C3 improved the validity of Criterion C. Conclusions: This study supports the use of the PTSD-AA excluding Criterion C3 for identifying highly traumatized children and adolescents following PICU admission.