Background: Approximately 145,000 children and adolescents are living with lasting cognitive, physical, or behavioral effects of TBIs. While moderate and severe TBIs account for the majority of TBI-related deaths, 80–90% of all pediatric TBIs are mild in severity. The specific factors that contribute to persistent post-concussive symptoms are poorly understood and are likely the result of coexisting and/or confounding factors that may not be explained solely by brain pathology. Misattribution of health- and cognitive-related disabilities and functional impairments to brain injury alone has the potentially detrimental implication that recovery from mTBI depends predominantly on neurologic factors. Failure to consider mental health symptoms may lead to inappropriate or inefficient treatment of symptoms and prolonged recovery. 

Objective: The purpose of this study was to examine the predictive utility of specific post-concussive symptoms reported during the Emergency Department (ED) visit in the acute aftermath of a mTBI predicted prolonged recovery of more than 10 days. 

Methods: Data was retrieved through retrospective chart review of patients treated in the ED for post-concussive symptoms and followed up with Sports Medicine or Neurology. Participants included pediatric patients age 9 – 18 years who were administered the Acute Concussion Evaluation (ACE) during their ED visit. Patients were excluded if they were admitted or had abnormal CT scans, or had a history of neurologic disorders, personal history of migraines, developmental disorders, or psychiatric history as there has been suggestion that these factors may predispose patients to having prolonged symptoms. Prolonged recovery was determined as time until determined able to “return to normal activity” by the medical provider. 

Results: One hundred and twenty four children were included in analyses. The average age was 14.1 years and the average time to follow up in the subspecialist clinic was 9.6 days.  Sixty three children (50.8%) had reported significant levels of post-concussive symptoms 10 days post-injury. Logistical regression analyses indicated that children with symptoms of loss of consciousness, dizziness, and nausea at initial ED evaluation were not more likely to have prolonged symptoms than those who did not report these symptoms (p>0.05).  However, children who reported nervousness or sadness (p=0.04 and p=0.05 respectively) in the ED were more likely to have prolonged recovery. 

Implications: Findings underscore the importance of considering psychological symptoms in the assessment and treatment of mTBI. However, findings are limited by the retrospective nature of the study and lack of standardized outcome measures. Additional prospective research is needed examining the various trajectories of mTBI recovery and how specific post-concussive symptoms may interact over time to prolong a child’s recovery. Furthermore, research should test ways in which ED’s can implement ways to help children cope with emotional lability as a way to improve recovery from concussion.

Examination of Specific Acute mTBI Symptoms in Predicting Prolonged Recovery in Pediatric Patients