Each year, more than 40 million Americans present to US emergency departments (EDs) for evaluation after trauma exposure. While the majority of these individuals recover, an important subset develops adverse posttraumatic neuropsychiatric sequelae. These posttraumatic neuropsychiatric sequelae include traditionally categorized outcomes such as posttraumatic stress disorder (PTSD), depression, minor traumatic brain injury (MTBI), and regional or widespread pain. However, these previous definitions of outcome have limited progress, and we now appreciate that the actual trajectories of posttraumatic neuropsychiatric sequelae are multidimensional, incorporating a range of specific outcomes that may be best understood, and optimally targeted for intervention, by dividing across specific domains of functioning. Available clinical trial data provide preliminary evidence that the risk of such posttraumatic neuropsychiatric sequelae can be significantly reduced by early preventive interventions. However, the development of such preventive interventions is currently prevented by the following critical barriers: (1) limited understanding of posttraumatic neuropsychiatric sequelae at a biobehavioral level; (2) limited understanding of pathophysiologic mechanisms of posttraumatic neuropsychiatric sequelae onset and course; and (3) a lack of risk prediction tools that accurately and comprehensively determine those posttraumatic neuropsychiatric sequelae to which an
individual is vulnerable.

The AURORA study represents a major national initiative to improve the understanding, prevention, and treatment of posttraumatic neuropsychiatric sequelae. Five thousand participants who present to the emergency department for evaluation after trauma exposure, meet screening and eligibility criteria, and consent to the study will undergo a brief baseline assessment of trauma-related, psychosocial, neurocognitive, and biological factors. Participants will then receive ecological monitoring, and will complete physiologic, biologic, neurocognitive, symptom, and health outcome assessments during one-year follow-up. Subsamples of study participants will undergo in-person deep phenotyping at 2 weeks and 6 months, consisting of biologic collection, functional magnetic resonance imaging (fMRI), and psychophysical evaluation. The wealth of first-in-kind information gained from this study will be used to overcome critical barriers to the prevention and treatment of common, morbid posttraumatic neuropsychiatric sequelae, and will allow the development of urgently needed preventive/treatment interventions for civilian and veteran populations that experience tremendous suffering.