The goal of this observational study is to develop and validate a clinical tool to predict which adolescents aged 11 to less than 18 years of age with mild traumatic brain injury (mTBI) are at an increased risk for developing significant new or worsening mental health conditions.
The main aims the study wish to answer are:
* Does the adolescent have new or worsening depression or anxiety defined as a change from their previous medical history using self-reported questionnaires at either one or three months post-injury? * Does the adolescent have unmet mental health care needs, defined as not receiving any mental or behavior health care in patients with new or worsening anxiety or depression as defined by the self reported questionnaires?
Participants will be enrolled after being diagnosed in the emergency department (ED) with an mTBI. During the ED visit, the child's parent/caregiver and the adolescent will complete several questionnaires related to mental health which include tools to measure anxiety and depression. Participants will be asked to complete these questionnaires again at 1 month and 3 months post enrollment.
None
Presentation to the ED >72 hours post-injury
TBI requiring emergent neurosurgical intervention at the time of enrollment
Other injuries requiring emergent surgery at the time of enrollment
Parent or child unable to accurately complete the study questionnaires due to preexisting functional limitations (e.g., severe developmental delay)
Participants are injured children aged 11 to 17 years old who present with a Mild traumatic brain injury (mTBI), including concussion, as defined by the Centers for Disease Control and Prevention as an acute brain injury resulting in neurological symptoms such as confusion or disorientation, loss of consciousness, amnesia, seizure, or other signs or symptoms combined with a Glasgow Coma Scale (GCS) score of 13 to 15 to one of six emergency departments (EDs) throughout the United States.
Cohort
Prospective
Validated Questionnaires
BehavioralGeneralized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), The Rivermead Post Concussion Symptom Questionnaire (Rivermead), Pediatric Quality of Life Inventory (PedsQL), Strengths and Difficulties Questionnaire (SDQ)
Questionnaires
BehavioralEarly Physical Activity/Return to School Questionnaire, Mental Health Utilization Questionnaire
Clinician / Medical Record Variables
Other interventionMedical History, Emergency Department Clinical Variables
New or worsening depression or anxiety
New or worsening depression or anxiety are binary variables (yes/no) defined as a change from the retrospective baseline score collected on the self-reported Generalized Anxiety Disorder-7 questionnaire (GAD-7) equal to or greater than 4 points, and/or a change from the baseline score collected on the self-reported Patient Health Questionnaire-8 (PHQ-8) equal to or greater than 5 points. The Generalized Anxiety Disorder-7 (GAD-7) contains seven items, each of which is scored 0 to 3, providing a 0 to 21 severity score where higher values indicate worsening severity. The Patient Health Questionnaire-8 (PHQ-8) contains eight items, each of which is scored 0 to 3, providing a 0 to 24 severity score where higher values indicate worsening severity.
Unmet mental health care needs in patients with new or worsening depression or anxiety
Unmet mental health care needs are defined as a binary variable (yes/no) if participants received any mental or behavioral health care as collected on the self-reported Mental Health Utilization Questionnaire completed the parent of the participant. Mental or behavioral health care includes, but is not limited to behavioral, cognitive-behavioral, interpersonal therapy, psychotherapy, and counseling. Medications alone will not fulfill the criteria of mental or behavior health care.
Decline in quality of life
A decline in the patient's quality of life is a binary variable (yes/no) defined as a decrease from the retrospective baseline score collected on the self-reported Pediatric Quality of Life Inventory questionnaire (PedsQL) equal to or greater than a 4.5 points. The Pediatric Quality of Life Inventory questionnaire (PedsQL) contains 23 items, each of which is scored 0 to 4, and is scored on a range from 0 to 100, with lower scores indicated a lower quality of life.
Persistent mTBI symptoms
Persistent mTBI is a binary variable (yes/no) defined as an increase from the retrospective baseline score collected on the Rivermead Post Concussion Questionnaire of greater than or equal to 2 points on any three symptoms. The Rivermead Post Concussion Questionnaire consists of the sixteen items divided into two groups. The first three items make up the first sub-group scored from 0 to 12, and the next 13 items make up the second sub-group scored from 0 to 52. The entire questionnaire is scored from 0 to 64 where higher values indicate worsening severity.
New deficits in emotional/behavioral functioning or hyperactivity/inattention
The Strengths and Difficulties Questionnaire (SDQ) is comprised of 4 sub scales of 5 items each for a total of 20 questions. Each sub scale has a minimum score of 0 and a maximum score of 10 where higher values indicate worsening severity. New deficits in emotional/behavioral functioning or participant hyperactivity/inattention are binary variables (yes/no) defined as a new score of 5 points or greater on the emotional/behavioral functioning sub scales or 6 points or greater on the hyperactivity/inattention sub scale as collected from the self-reported Strengths and Difficulties Questionnaire (SDQ).
Parent Perception of Unmet Mental Health Needs
Parent Perception of Unmet Mental Health Needs is a binary variable (yes/no) defined as the parent perception of unmet mental health needs in participants with new or worsening anxiety or depression identified at the 1 month and 3 month follow up visits. This will be assessed using the Mental Health Utilization Questionnaire completed by parents. Unmet mental health care needs are defined as a binary variable (yes/no) if participants received any mental or behavioral health care as collected on the self-reported Mental Health Utilization Questionnaire completed the parent of the participant.
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University of California, Davis
Lead sponsor
Pediatric Emergency Care Applied Research Network
Collaborator
