Acute Emotional Symptoms Predict Emotional Functioning Up to 6 Months After Pediatric Concussion: An A-CAP Study

To determine whether acute emotional symptoms were elevated and associated with subsequent emotional functioning after concussion in children and adolescents.

This prospective, longitudinal observational study consecutively recruited children (ages 8-17 years) with concussion or mild orthopedic injury (OI) who presented acutely (≤48 hours) to 5 pediatric emergency departments. Acute emotional symptoms were rated using the Acute Concussion Evaluation. Pre- and post-injury emotional functioning were measured using 3 standardized and validated parent and child report questionnaires at 1 week (post-acutely), 3 months, and 6 months post-injury. Poisson regression and linear mixed-effects modeling were used to compare groups in acute emotional symptoms and the association between acute emotional symptoms and later emotional functioning.

Of 3,051 children approached, 967 enrolled in the study, and 793 (82%; 509 concussion/284 OI; 57.6% male; age 12.4±2.40 years) had acute and follow-up emotional symptom data. Greater acute emotional symptoms were more likely following concussion vs OI for males (IRR=1.37) and especially females (IRR=2.12). Emotional functioning was worse following concussion relative to OI (parent and child d=-0.31 and -0.33), across time, age, and sex. More acute emotional symptoms (4 vs 0) predicted worse emotional functioning after concussion vs OI 1-week post-injury (post-acutely) in younger children (d=-1.05), 3 months post-injury in females (d=-1.10), and across sex (d=0.67). In post hoc follow-up analyses, odds of clinically elevated emotional dysfunction were higher after concussion vs OI 1-week post-injury for younger children (OR=95.05, 95% CI 1.53, 5,900) and 3 months post-injury for older children (OR=468.43, 95% CI 1.41, 155,000).

More acute emotional symptoms following concussion predict worse emotional functioning up to 6 months post-injury. Acute emotional symptom screening may identify at-risk children.