342 Smartphone and Wrist-Wearable-Based Biomarkers of Pain Severity After Emergency Department Discharge: Preliminary Results From the AURORA Study

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Conference Proceeding

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Ann Emerg Med


Study Objectives: Adverse posttraumatic neuropsychiatric sequelae (APNS) such as posttraumatic pain cause great suffering in civilian trauma survivors and military personnel and are traditionally evaluated using self-report symptoms alone. Objective biobehavioral indicators are needed to more fully characterize posttraumatic phenotypes, gain new insights into pathophysiologic mechanisms, better understand patient experiences, and improve the assessment of patient recovery. Identifying objective biobehavioral indicators of APNS is a goal of the ongoing AURORA study, a ∼40 million-dollar effort funded by NIH, the DoD, and foundation and industry partners. Methods: AURORA performs serial assessments of neurocognitive, physiologic, digital phenotype, psychophysical, neuroimaging, and genomic domains in thousands of individuals who present to the ED after trauma exposure. The present analysis performed initial screening for state biomarkers of pain severity during the first eight weeks after trauma in an initial study sample (=867). Pain severity was assessed using latent variables developed from self-report questions administered via the Mindstrong smartphone App at six timepoints during the first eight weeks after trauma. State biomarkers were screened from two domains: heart rate variability (HRV) data were obtained from the Verily Study Watch, provided to all participants at the time of ED discharge, and activity metrics derived from the Mindstrong app. Associations between changes in pain severity and changes in candidate state biomarkers over time were assessed using Pearson correlation. Results: In screening analyses, a number of promising state biomarkers of pain severity were identified from both HRV and activity domains. Promising state biomarkers included measures of heart rate variability (eg, elevations in high frequency power, p





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