Incidence and determinants of acute stress disorder after supracondylar humeral fracture surgery in school-age children

Table 1 Comparison of demographic characteristics of study subjects (n = 284), mean ± SD/n (%)

Characteristic	Total (n = 284)	ASD group (n = 67)	Non-ASD group (n = 217)	Statistic	P value
Age (years)	8.7 ± 1.8	8.9 ± 1.7	8.6 ± 1.8	t = 1.234	0.218
6-8	118 (41.5)	25 (37.3)	93 (42.9)
9-12	166 (58.5)	42 (62.7)	124 (57.1)
Gender				χ2 = 0.548	0.459
Male	167 (58.8)	42 (62.7)	125 (57.6)
Female	117 (41.2)	25 (37.3)	92 (42.4)
Residence				χ2 = 2.698	0.100
Urban	179 (63.0)	48 (71.6)	131 (60.4)
Rural	105 (37.0)	19 (28.4)	86 (39.6)
Family economic status				χ2 = 5.247	0.073
Low income (< 5000 yuan)	89 (31.3)	28 (41.8)	61 (28.1)
Middle income (5000-10000 yuan)	128 (45.1)	26 (38.8)	102 (47.0)
High income (> 10000 yuan)	67 (23.6)	13 (19.4)	54 (24.9)
Family structure				χ2 = 8.764	0.033
Nuclear family	198 (69.7)	39 (58.2)	159 (73.3)
Extended family	56 (19.7)	16 (23.9)	40 (18.4)
Single-parent family	24 (8.5)	10 (14.9)	14 (6.5)
Others	6 (2.1)	2 (3.0)	4 (1.8)

ASD: Acute stress disorder.

Table 2 Comparison of disease-related characteristics of study subjects (n = 284), n (%)/mean ± SD

Characteristic	Total (n = 284)	ASD group (n = 67)	Non-ASD group (n = 217)	Statistic	P value
Fracture type (Gartland classification)				χ2 = 8.472	0.014
Type I	47 (16.5)	6 (9.0)	41 (18.9)
Type II	156 (54.9)	32 (47.8)	124 (57.1)
Type III	81 (28.5)	29 (43.3)	52 (24.0)
Injury mechanism				χ2 = 6.741	0.150
Fall	162 (57.0)	34 (50.7)	128 (59.0)
Traffic accident	48 (16.9)	16 (23.9)	32 (14.7)
Sports injury	52 (18.3)	12 (17.9)	40 (18.4)
Violence	15 (5.3)	4 (6.0)	11 (5.1)
Others	7 (2.5)	1 (1.5)	6 (2.8)
Surgical method				χ2 = 4.127	0.127
Closed reduction with percutaneous pinning	201 (70.8)	41 (61.2)	160 (73.7)
Open reduction with internal fixation	78 (27.5)	24 (35.8)	54 (24.9)
Others	5 (1.8)	2 (3.0)	3 (1.4)
Pain intensity (Wong-Baker scale)	5.8 ± 2.4	7.2 ± 2.1	5.4 ± 2.3	t = 5.896	< 0.001
Postoperative complications				χ2 = 12.634	< 0.001
None	241 (84.9)	48 (71.6)	193 (88.9)
Present	43 (15.1)	19 (28.4)	24 (11.1)

ASD: Acute stress disorder.

Table 3 Comparison of psychosocial factors of study subjects (n = 284), n (%)/mean ± SD

Characteristic	Total (n = 284)	ASD group (n = 67)	Non-ASD group (n = 217)	Statistic	P value
Previous trauma history				χ2 = 8.129	0.004
None	201 (70.8)	38 (56.7)	163 (75.1)
Present	83 (29.2)	29 (43.3)	54 (24.9)
Family support (FACES-IV)	68.5 ± 12.3	61.2 ± 14.6	70.8 ± 10.4	t = -5.823	< 0.001
Good (≥ 70 points)	156 (54.9)	22 (32.8)	134 (61.8)
Moderate (50-69 points)	102 (35.9)	32 (47.8)	70 (32.3)
Poor (< 50 points)	26 (9.2)	13 (19.4)	13 (6.0)
Coping strategy efficacy total score (Kidcope)	6.2 ± 2.1	5.1 ± 2.3	6.5 ± 1.9	t = -4.968	< 0.001
High efficacy (≥ 7 points)	118 (41.5)	18 (26.9)	100 (46.1)
Moderate efficacy (4-6 points)	124 (43.7)	32 (47.8)	92 (42.4)
Low efficacy (< 4 points)	42 (14.8)	17 (25.4)	25 (11.5)
Coping strategy effectiveness total score (Kidcope)	18.4 ± 6.7	14.6 ± 7.2	19.6 ± 6.1	t = -5.674	< 0.001
High effectiveness (≥ 22 points)	89 (31.3)	12 (17.9)	77 (35.5)
Moderate effectiveness (15-21 points)	127 (44.7)	28 (41.8)	99 (45.6)
Low effectiveness (< 15 points)	68 (23.9)	27 (40.3)	41 (18.9)

FACES-IV: Family Adaptability and Cohesion Evaluation Scales fourth edition; ASD: Acute stress disorder.

Table 4 Cognitive function assessment Mini-Mental State Examination for children results of study subjects (n = 284), mean ± SD

Cognitive function dimension	Total (n = 284)	ASD group (n = 67)	Non-ASD group (n = 217)	Statistic	P value
MMSE-C total score	27.8 ± 1.6	27.6 ± 1.8	27.9 ± 1.5	t = -1.245	0.214
Orientation score	9.7 ± 0.6	9.6 ± 0.7	9.7 ± 0.5	t = -1.089	0.277
Memory score	5.6 ± 0.7	5.5 ± 0.8	5.6 ± 0.6	t = -1.156	0.248
Attention and calculation score	4.7 ± 0.6	4.6 ± 0.7	4.7 ± 0.5	t = -1.078	0.282
Language ability score	7.5 ± 0.8	7.4 ± 0.9	7.5 ± 0.7	t = -0.892	0.373
Visuospatial ability score	0.96 ± 0.2	0.94 ± 0.2	0.97 ± 0.2	t = -1.201	0.231

MMSE-C: Mini-Mental State Examination for children; ASD: Acute stress disorder.

Table 5 Comparison of acute stress disorder symptoms (Child Acute Stress Disorder Scale) dimensional scores (n = 284), mean ± SD

CASDS dimension	Total (n = 284)	ASD group (n = 67)	Non-ASD group (n = 217)	Statistic	P value
CASDS total score	21.4 ± 12.8	35.2 ± 8.6	17.1 ± 9.4	t = 15.896	< 0.001
Intrusive symptoms dimension	6.8 ± 4.2	11.2 ± 3.1	5.4 ± 3.6	t = 12.456	< 0.001
Avoidance symptoms dimension	2.1 ± 1.8	3.9 ± 1.4	1.6 ± 1.5	t = 11.234	< 0.001
Negative alterations in cognitions and mood dimension	6.4 ± 3.9	10.8 ± 2.8	5.1 ± 3.2	t = 13.567	< 0.001
Alterations in arousal and reactivity dimension	6.1 ± 3.7	9.3 ± 2.9	5.0 ± 3.1	t = 10.892	< 0.001

CASDS: Child Acute Stress Disorder Scale; ASD: Acute stress disorder.

Table 6 Comparison of anxiety and depression scale scores (n = 284), mean ± SD

Scale and dimension	Total (n = 284)	ASD group (n = 67)	Non-ASD group (n = 217)	Statistic	P value
SCARED anxiety scale
SCARED total score	22.1 ± 14.6	32.8 ± 15.2	18.9 ± 12.4	t = 7.456	< 0.001
Somatic/panic disorder	6.2 ± 4.1	9.1 ± 4.8	5.3 ± 3.4	t = 6.789	< 0.001
Generalized anxiety disorder	7.8 ± 5.2	11.2 ± 5.6	6.8 ± 4.7	t = 6.234	< 0.001
Separation anxiety disorder	4.1 ± 3.2	6.3 ± 3.8	3.4 ± 2.7	t = 6.456	< 0.001
Social phobia	2.9 ± 2.8	4.2 ± 3.1	2.5 ± 2.5	t = 4.567	< 0.001
School phobia	1.1 ± 1.6	2.0 ± 1.9	0.9 ± 1.4	t = 4.892	< 0.001
CDI depression scale
CDI total score	16.8 ± 11.2	25.4 ± 12.6	13.9 ± 9.4	t = 7.892	< 0.001

SCARED: Screen for Child Anxiety Related Emotional Disorders; CDI: Children’s Depression Inventory; ASD: Acute stress disorder.

Table 7 Detection of anxiety and depression disorders (n = 284), n (%)

Type of psychological disorder	Total (n = 284)	ASD group (n = 67)	Non-ASD group (n = 217)	χ2	P value	OR (95%CI)
Anxiety disorders
Overall anxiety disorder (≥ 25 points)	89 (31.3)	37 (55.2)	52 (24.0)	24.567	< 0.001	3.89 (2.18-6.95)
95%CI	25.9%-36.7%	42.8%-67.6%	18.3%-29.7%
Somatic/panic disorder (≥ 7 points)	62 (21.8)	28 (41.8)	34 (15.7)	19.865	< 0.001	3.84 (2.02-7.31)
Generalized anxiety disorder (≥ 9 points)	72 (25.4)	31 (46.3)	41 (18.9)	20.123	< 0.001	3.71 (2.01-6.85)
Separation anxiety disorder (≥ 5 points)	53 (18.7)	24 (35.8)	29 (13.4)	16.789	< 0.001	3.58 (1.85-6.93)
Social phobia (≥ 8 points)	40 (14.1)	18 (26.9)	22 (10.1)	11.234	0.001	3.25 (1.62-6.52)
School phobia (≥ 3 points)	33 (11.6)	15 (22.4)	18 (8.3)	8.765	0.003	3.18 (1.48-6.84)
Depression symptoms
Depression symptoms (≥ 19 points)	68 (23.9)	31 (46.3)	37 (17.1)	23.456	< 0.001	4.18 (2.26-7.73)
95%CI	19.0%-28.8%	34.0%-58.6%	12.1%-22.1%
Mild depression (19-28 points)	45 (15.8)	18 (26.9)	27 (12.4)	8.234	0.004	2.58 (1.31-5.08)
Moderate depression (29-40 points)	18 (6.3)	10 (14.9)	8 (3.7)	9.567	0.002	4.51 (1.71-11.89)
Severe depression (≥ 41 points)	5 (1.8)	3 (4.5)	2 (0.9)	3.128	0.077	5.11 (0.84-31.06)

CI: Confidence interval; ASD: Acute stress disorder; OR: Odds ratio.

Table 8 Univariate analysis of factors influencing acute stress disorder, mean ± SD/n (%)

Influencing factor	ASD group (n = 67)	Non-ASD group (n = 217)	χ2/t value	P value
Demographic characteristics
Age (years)	8.9 ± 1.7	8.6 ± 1.8	1.234	0.218
Gender			0.548	0.459
Male	42 (62.7)	125 (57.6)
Female	25 (37.3)	92 (42.4)
Residence			2.698	0.100
Urban	48 (71.6)	131 (60.4)
Rural	19 (28.4)	86 (39.6)
Family economic status			5.247	0.073
Low income	28 (41.8)	61 (28.1)
Middle income	26 (38.8)	102 (47.0)
High income	13 (19.4)	54 (24.9)
Family structure			8.764	0.033
Nuclear family	39 (58.2)	159 (73.3)
Extended family	16 (23.9)	40 (18.4)
Single-parent family	10 (14.9)	14 (6.5)
Others	2 (3.0)	4 (1.8)
Disease-related factors
Fracture type			8.472	0.014
Type I	6 (9.0)	41 (18.9)
Type II	32 (47.8)	124 (57.1)
Type III	29 (43.3)	52 (24.0)
Pain intensity	7.2 ± 2.1	5.4 ± 2.3	5.896	< 0.001
Postoperative complications			12.634	< 0.001
Present	19 (28.4)	24 (11.1)
Psychosocial factors
Previous trauma history			8.129	0.004
Present	29 (43.3)	54 (24.9)
Family support status	61.2 ± 14.6	70.8 ± 10.4	-5.823	< 0.001
Coping strategy efficacy total score	5.1 ± 2.3	6.5 ± 1.9	-4.968	< 0.001
Coping strategy effectiveness total score	14.6 ± 7.2	19.6 ± 6.1	-5.674	< 0.001

ASD: Acute stress disorder.

Table 9 Multivariate logistic regression analysis of factors influencing acute stress disorder

Influencing factor	B	SE	Wald	P value	aOR	95%CI
Fracture type			7.896	0.019
Type II vs type I	0.892	0.457	3.814	0.051	2.44	0.99-6.00
Type III vs type I	1.347	0.482	7.805	0.005	3.85	1.50-9.88
Pain intensity (per 1-point increase)	0.234	0.067	12.125	< 0.001	1.26	1.11-1.44
Postoperative complications (present vs absent)	0.987	0.358	7.608	0.006	2.68	1.33-5.41
Previous trauma history (present vs absent)	0.756	0.318	5.647	0.017	2.13	1.14-3.98
Family support status (per 1-point increase)	-0.048	0.014	11.689	0.001	0.95	0.93-0.98
Constant	0.125	1.246	0.010	0.920	1.13

Excluded variables and reasons: (1) Family structure and family economic status were excluded due to P > 0.10 in multivariate analysis; (2) Residence was excluded due to collinearity with family economic status; and (3) Coping strategy efficacy and effectiveness total scores had collinearity with family support status, so family support status with larger effect size was selected for the model. aOR: Adjusted odds ratio; CI: Confidence interval.