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

Figshare · 2026-04-07

Abstract Background 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. Methods 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. Discussion 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. Trial registration ClinicalTrials.gov Identifier: NCT06370520. Registered March 20, 2024. The study protocol has been approved by the Institutional Review Boards at all participating sites.

Implementing an Education Intervention for Prescription Opioid Pain Medication at Pediatric Trauma Centers

Figshare · 2026-01-01

Adolescents treated in trauma centers are frequently prescribed opioid pain medication for pain management at hospital discharge. There has been an increase in adolescent opioid overdose deaths requiring additional education on risks associated with opioid pain medication use in this population. The objective of this analysis was to assess the implementation at ten US pediatric trauma centers of an opioid pain medication prevention education intervention and whether implementation of the intervention was also associated with an increase of delivery of pain medication education and a reduction in opioid prescribing. Across all sites during the study period, 4,371 adolescent patients received an opioid pain medication at discharge. Opioid pain medication education increased from 20.9% before the intervention’s implementation to 37.3% (<i>p</i> = 0.0001) after implementation. There was also a significant increase in adolescent patients with positive screens on admission for alcohol or drugs in getting opioid pain medication education after the implementation. Additionally, there was a modest decrease in opioid prescribing at discharge from pre- to post-implementation of the intervention: 54.7% to 48.8% (<i>p</i> &lt; 0.0001). An intervention that includes training staff on delivery of opioid pain medication education for adolescents and family members can improve education provided to patients being prescribed opioid pain medication at discharge from pediatric trauma centers.

Response to the Letter to the Editor Regarding “Presentation and Diagnosis of Spondylolysis”

Pediatric Emergency Care · 2026-04-01

Additional file 1 of Screening Emotions in Adolescents Receiving Care at the Hospital for mild Traumatic Brain Injury (SEARCH-mTBI): protocol for a multicenter observational study

Figshare · 2026-04-07

Supplementary Material 1.

Pediatric Post‐Tonsillectomy Hemorrhage Management: A Cross‐Sectional Otolaryngology and Emergency Medicine Survey

Laryngoscope Investigative Otolaryngology · 2026-03-04

ABSTRACT Objectives To evaluate current trends and management strategies for post‐tonsillectomy hemorrhage (PTH) among otolaryngology (ENT) and emergency medicine (EM) physicians. Methods A survey was developed by a panel of pediatric ENT, critical care, and EM physicians. Questions assessed therapies and definitions of PTH. Survey distribution was to members of the American Society of Pediatric Otolaryngology (ASPO) and a common pediatric emergency medicine listserv (PED‐EM‐L). Results Overall response rate was low at 6.5% (ENT: 110, EM: 134, Total: 244). Compared with EM respondents, ENT providers were more likely to have over 10 years of experience (60% vs. 46%; p = 0.023). ENT providers were less likely to include “return to the operating room” as a defining feature of post‐tonsillectomy hemorrhage (59% vs. 81%; p &lt; 0.001) and less likely to estimate that ≥ 10% of patients require reoperation for bleeding (17% vs. 71%; p &lt; 0.001). PTH non‐operative managements selected as most likely to be used in the past 6 months were observation (ENT: 44% vs. EM: 55%), nebulized tranexamic acid (TXA) (ENT: 29% vs. EM: 66%), intravenous TXA (ENT: 16% vs. EM: 31%), direct pressure (ENT: 4% vs. EM: 10%), and topical agents such as salt water gargle (ENT: 7% vs. EM: 19%). After adjusting for confounders (gender, PTH definition, percent returning to operating room, years in practice, practice setting), ENT providers were less likely to use nebulized TXA compared to EM respondents ( p &lt; 0.001). Conclusion Significant variability exists between ENT and EM providers in the definition and use of TXA for PTH. Larger, well‐designed studies and targeted educational initiatives are needed to validate and standardize non‐operative strategies for PTH management.

Implementing an Education Intervention for Prescription Opioid Pain Medication at Pediatric Trauma Centers

Substance Use & Misuse · 2026-01-02

BACKGROUND: Adolescents treated in trauma centers are frequently prescribed opioid pain medication for pain management at hospital discharge. There has been an increase in adolescent opioid overdose deaths requiring additional education on risks associated with opioid pain medication use in this population. OBJECTIVES: The objective of this analysis was to assess the implementation at ten US pediatric trauma centers of an opioid pain medication prevention education intervention and whether implementation of the intervention was also associated with an increase of delivery of pain medication education and a reduction in opioid prescribing. RESULTS: < 0.0001). CONCLUSION: An intervention that includes training staff on delivery of opioid pain medication education for adolescents and family members can improve education provided to patients being prescribed opioid pain medication at discharge from pediatric trauma centers.

Implementing an Education Intervention for Prescription Opioid Pain Medication at Pediatric Trauma Centers

Figshare · 2026-01-01

Adolescents treated in trauma centers are frequently prescribed opioid pain medication for pain management at hospital discharge. There has been an increase in adolescent opioid overdose deaths requiring additional education on risks associated with opioid pain medication use in this population. The objective of this analysis was to assess the implementation at ten US pediatric trauma centers of an opioid pain medication prevention education intervention and whether implementation of the intervention was also associated with an increase of delivery of pain medication education and a reduction in opioid prescribing. Across all sites during the study period, 4,371 adolescent patients received an opioid pain medication at discharge. Opioid pain medication education increased from 20.9% before the intervention’s implementation to 37.3% (<i>p</i> = 0.0001) after implementation. There was also a significant increase in adolescent patients with positive screens on admission for alcohol or drugs in getting opioid pain medication education after the implementation. Additionally, there was a modest decrease in opioid prescribing at discharge from pre- to post-implementation of the intervention: 54.7% to 48.8% (<i>p</i> &lt; 0.0001). An intervention that includes training staff on delivery of opioid pain medication education for adolescents and family members can improve education provided to patients being prescribed opioid pain medication at discharge from pediatric trauma centers.

Additional file 1 of Screening Emotions in Adolescents Receiving Care at the Hospital for mild Traumatic Brain Injury (SEARCH-mTBI): protocol for a multicenter observational study

Figshare · 2026-04-07

Supplementary Material 1.

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

BMC Pediatrics · 2026-04-06

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.

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

Figshare · 2026-04-07

Abstract Background 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. Methods 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. Discussion 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. Trial registration ClinicalTrials.gov Identifier: NCT06370520. Registered March 20, 2024. The study protocol has been approved by the Institutional Review Boards at all participating sites.