Ketamine and Pediatric PTSD: A Retrospective Analysis of Risk Following Anesthesia for Fractures

Abstract Introduction: Ketamine is widely used for pediatric procedural sedation, but its long-term psychological effects remain unclear. This study examines the incidence of post-traumatic stress disorder (PTSD) and depression in children receiving ketamine versus other anesthetics for fracture management. Methods: A retrospective cohort study was conducted on 677,189 children aged 6–18 who received ketamine or another anesthetic. After 1:1 propensity score matching, the final cohort included 15,250 cases and 15,250 controls for PTSD and depression analyses. PTSD and depression incidence were assessed at 1 week, 1 month, 6 months, and 1 year post-exposure using survival analysis and risk estimation. Results: Children in the ketamine group had a significantly higher risk of PTSD at 1 month (RR = 2.4, p = 0.016), 6 months (RR = 1.89, p = 0.026), and 1 year (RR = 1.70, p = 0.026). Kaplan-Meier analysis confirmed a lower probability of PTSD-free survival in the ketamine group. No significant difference in depression risk was observed at any time point (p > 0.05). Conclusion: Ketamine exposure in children was associated with increased PTSD risk up to 1 year post-exposure, while no impact on depression was observed. These findings highlight the importance of long-term psychological monitoring following ketamine administration. Further research is needed to explore underlying mechanisms and potential mitigation strategies.