Screening Emotions in Adolescents Receiving Care at the Hospital for mild Traumatic Brain Injury (SEARCH-mTBI): protocol for a multicenter observational study

Mild traumatic brain injury (mTBI) is a common pediatric condition with growing recognition of its impact on mental health. While most children recover within weeks of the injury, a subset experience persistent emotional symptoms, including anxiety and depression. Early identification of youth at risk for adverse mental health outcomes is essential for timely intervention. Our primary study objective is to develop a robust clinical prediction tool to identify children at risk for adverse mental health outcomes after mTBI. We will conduct a multicenter prospective observational cohort study enrolling patients aged 11–17 years who present to the emergency department (ED) with mTBI within 3 days from injury. We will enroll consecutive patients into separate derivation and validation cohorts using different enrolling sites. Baseline data, including pre-injury mental health status, and clinical variables will be collected from patients, caregivers, and ED clinicians. We will collect validated measures during the acute period (1 to 2 weeks), 1-month, and 3-months post-injury including: the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), Pediatric Quality of Life Inventory (PedsQL), Rivermead Post-Concussion Symptoms Questionnaire, and the Strengths and Difficulties Questionnaire (SDQ). Our primary outcome is a composite measure of clinically significant new or worsening in anxiety or depression at 1 or 3 months. Secondary outcomes include persistent post-concussive symptoms, reduced quality of life, and new behavioral or emotional difficulties. We will analyze associations between baseline factors and outcomes to derive and validate a clinical prediction tool. Our study will provide a comprehensive assessment of mental health and other outcomes following mTBI in adolescents and identify predisposing factors for adverse outcomes. Our findings will contribute to the development of a clinical prediction tool to support early identification and referral for at-risk youth. Study results may inform post-injury care pathways and targeted interventions aimed at improving long-term recovery. ClinicalTrials.gov Identifier: NCT06370520. Registered March 20, 2024. The study protocol has been approved by the Institutional Review Boards at all participating sites.