Multidomain Post-Concussive Symptom Trajectories and Biopsychosocial Correlates Following Pediatric Concussion

Understanding how post-concussive symptoms (PCS) evolve across multiple domains and how these patterns relate to biopsychosocial factors is critical for identifying children at risk of prolonged recovery following concussion.

To identify clinically meaningful recovery groups characterized by shared trajectories of cognitive, physical, emotional, and fatigue PCS over 3 months post-injury, and to examine associations between trajectory group membership and pre-injury, injury-related, and biopsychosocial factors.

This prospective longitudinal cohort study was conducted at the Royal Children's Hospital, Victoria, Australia. Participants were children aged 5-18 years presenting to the emergency department (ED) with concussion.

Cognitive, physical, emotional, and fatigue PCS above pre-injury baseline were assessed via parent report using the Postconcussion Symptom Inventory at ED presentation and at 2-4 days, 2 weeks, 1 month, and 3 months post-injury. Group-based multi-trajectory modeling identified recovery groups. Associations with pre-injury, injury-related, psychosocial, and child factors were examined.

Among 326 children (231 males [70.9%]; mean [SD] age, 11.6 [3.2] years), five recovery trajectories were identified: resilient (n = 45, 14%), early recovery (n = 28, 9%), typical recovery (n = 146, 45%), delayed symptom exacerbation (n = 24, 7%), and persistently high symptom endorsement (n = 83, 25%). Exploratory comparisons suggested that persisting trajectories were associated with prior child mental health history and greater post-injury psychosocial difficulties.

Pediatric concussion symptom domains followed broadly similar time courses for most children; however, among children with delayed or persisting symptoms, some domains differed in the shape and timing of change. Recovery profiles characterized by persisting symptom endorsement were more strongly associated with psychosocial and mental health factors than with injury-related characteristics, underscoring the importance of early psychosocial screening and ongoing monitoring.