In the United States, about 2.8 million individuals are treated at hospitals annually for traumatic brain injuries (TBIs).¹ Most TBIs are classified as mild (mTBI) based on crude clinical signs, such as patients’ gross levels of consciousness up hospital admission (eg, Glasgow Coma Scale [GCS] scores of 13-15). Although it is well accepted that moderate to severe TBIs may cause permanent disability,^2-4 controversy exists surrounding the expected course of clinical recovery for patients with mTBI. In particular, although mTBI commonly causes acute symptoms,^5-7 cognitive dysfunction,^6,8-12 and problems in day-to-day functioning,¹³ findings vary as to whether patients continue to manifest sequelae of mTBI months to years postinjury.^14-16

Traumatic brain injury (TBI) is among the leading causes of death and disability worldwide, with enormous negative social and economic impacts. The heterogeneity of TBI combined with the lack of precise outcome measures have been central to the discouraging results from clinical trials. Current approaches to the characterization of disease severity and outcome have not changed in more than three decades. This prospective multicenter observational pilot study aimed to validate the feasibility of implementing the TBI Common Data Elements (TBI-CDEs). A total of 650 subjects who underwent computed tomography (CT) scans in the emergency department within 24 h of injury were enrolled at three level I trauma centers and one rehabilitation center. The TBI-CDE components collected included: 1) demographic, social and clinical data; 2) biospecimens from blood drawn for genetic and proteomic biomarker analyses; 3) neuroimaging studies at 2 weeks using 3T magnetic resonance imaging (MRI); and 4) outcome assessments at 3 and 6 months. We describe how the infrastructure was established for building data repositories for clinical data, plasma biomarkers, genetics, neuroimaging, and multidimensional outcome measures to create a high quality and accessible information commons for TBI research. Risk factors for poor follow-up, TBI-CDE limitations, and implementation strategies are described. Having demonstrated the feasibility of implementing the TBI-CDEs through successful recruitment and multidimensional data collection, we aim to expand to additional study sites. Furthermore, interested researchers will be provided early access to the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) data set for collaborative opportunities to more precisely characterize TBI and improve the design of future clinical treatment trials. (ClinicalTrials.gov Identifier NCT01565551.)

Importance Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. Objective To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). Design, Setting, and Participants Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist forDSM-5and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study. Main Outcomes and Measures Probable PTSD (PTSD Checklist forDSM-5score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. Results Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P < .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P = .03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. Conclusions and Relevance After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention.

Traumatic brain injury (TBI), considered as an event and/or a disease, initiates a complex pathophysiologic central nervous system cascade with acute effects and secondary insults that may lead to chronic functional, neurocognitive, and neuropsychiatric deficits.¹ Traumatic brain injury is classified according to its degree of severity (mild, moderate, and severe). In the United States, there are more than 3.5 million emergency department visits for TBI and more than 280 000 patients are hospitalized annually with TBI, with most of these classified as mild TBI (mTBI). There are also many more individuals with mTBI who never seek medical attention. More than 300 000 armed service members sustained TBI during combat and training from 2000 to 2014.² Approximately half of patients with TBI in the United States incur at least some short-term disability.³ Traumatic brain injury is associated with an increased risk of neurodegenerative disorders, such as Alzheimer disease, years or decades after injury.⁴ In addition, repetitive mTBI is a risk factor for a neurodegenerative condition called chronic traumatic encephalopathy (CTE).^5-7 Chronic traumatic encephalopathy, which can be confirmed only by postmortem neuropathologic examination, is defined by the abnormal accumulation of hyperphosphorylated tau protein (P-tau) in neurons, astroglia, and cell processes distributed around small blood vessels at the depth of cortical sulci in an irregular pattern.⁸