Michael A Lee, Heather A Shepherd, Masaru Teramoto, Miriam H Beauchamp, Brian L Brooks, Sahajdeep Chhina, William Craig, Quynh H Doan, Jocelyn Gravel, Angela Lumba-Brown, Michael Martyna, Karly Stillwell, Roger Zemek, Keith Owen Yeates, Ashley L Ware, Pediatric Emergency Research Canada A-CAP study team
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.
OBJECTIVE: To determine whether acute emotional symptoms were elevated and associated with subsequent emotional functioning after concussion in children and adolescents.
STUDY DESIGN: 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.
RESULTS: 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).
CONCLUSIONS: 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.