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Updated: Jul 18, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
5P Risk Classification Predicts Performance on Self-reported but Not Objective Clinical Outcomes at 4 Weeks
Elizabeth Teel1, Marie Brossard-Racine2, Laurie-Ann Corbin-Berrigan3
1Department of Health, Kinesiology, & Applied Physiology, Concordia University, Montreal, Quebec, Canada.
Insights
The Predicting and Preventing Postconcussive Problems in Pediatrics (5P) risk tool helps identify children with concussion who may experience prolonged recovery. It accurately predicts symptom, fatigue, physical activity, and quality of life outcomes at 4 weeks but not cognitive or balance issues.
Area of Science:
- Pediatric neurology
- Sports medicine
- Rehabilitation science
Background:
- Concussion recovery in children can be variable.
- Early identification of at-risk children is crucial for timely intervention.
- The Predicting and Preventing Postconcussive Problems in Pediatrics (5P) tool aims to stratify risk for persistent postconcussive symptoms.
Purpose of the Study:
- To evaluate if outcomes at 4 weeks post-concussion differ based on the 5P risk classification.
- To assess performance across symptom, cognitive, balance, fatigue, physical activity, and quality of life measures.
Main Methods:
- Prospective cohort study of 62 children diagnosed with concussion.
- Children were classified into high, moderate, or low risk using the 5P rule within 72 hours of injury.
- Outcomes were assessed at 4 weeks post-concussion using a multimodal battery; Kruskal-Wallis tests compared risk groups.
Main Results:
- Significant differences were found between 5P risk groups for symptom, fatigue, physical activity, and quality of life outcomes at 4 weeks.
- Low-risk children reported fewer symptoms and less fatigue, with higher physical activity and quality of life compared to high-risk children.
- No significant differences were observed in cognitive or balance outcomes between the groups.
Conclusions:
- The 5P rule effectively predicts self-reported outcomes (symptoms, fatigue, physical activity, quality of life) at 4 weeks post-concussion in children.
- The 5P tool does not appear to predict objective cognitive or balance outcomes.
- This prognostic information can aid clinicians in resource allocation for children at risk of prolonged concussion recovery.
Objective:
To determine if performance on symptom, cognitive, balance, fatigue, physical activity, and quality of life outcomes at 4 weeks postinjury in children with concussion differs based on acute Predicting and Preventing Postconcussive Problems in Pediatrics (5P) risk classification.
Design:
Prospective cohort.
Setting:
Laboratory.
Participants:
Sixty-two children (age: 13.27±2.50y; 29 [46.7%] women) with diagnosed concussion.
Interventions:
Not applicable.
Main Outcome Measures:
Patient demographics and postinjury assessments were completed within 72 hours of concussion and used to classify patients as "high," "moderate," or "low" persistent postconcussion symptoms risk. Children then completed a multimodal assessment battery at 4 weeks postconcussion. Kruskal-Wallis assessments analyzed whether study outcomes differed between 5P risk groups.
Results:
Significant group differences were observed in symptom (χ2(2)=9.76, P=.008), fatigue (χ2(2)=14.60, P<.001), physical activity (χ2(2)=15.76, P<.001), and quality of life (χ2(2)=7.82, P=.02) outcomes. The low-risk group had fewer symptoms and less fatigue but increased physical activity levels and quality of life compared with the high-risk group. No significant differences in cognitive or balance outcomes were observed (P>.05).
Conclusions:
The 5P rule provides clinicians with valuable prognostic information related to persistent postconcussion symptoms and self-reported outcomes 4 weeks postconcussion, but not objective cognitive or balance outcomes. This information may help clinicians prioritize treatment resources to children most at risk of prolonged concussion recovery.
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