Psychological Factors Associated with Delayed Symptom Resolution in Children with Concussion

J Pediatr. 2016 Jul;174:27-32.e1. doi: 10.1016/j.jpeds.2016.03.027. Epub 2016 Apr 11.


Objective: To characterize the psychological factors associated with persistent symptoms after pediatric concussion.

Study design: Longitudinal cohort study of 179 children with concussion 8-18 years old evaluated in a pediatric emergency department. Participants were followed for 1 month for delayed symptom resolution, defined as ≥3 symptoms that were new/worse than preinjury symptoms measured by the use of graded symptom inventory. Preinjury psychological traits were measured by parental report on subscales of the Personality Inventory for Children-2 (maladjustment, cognitive abilities, somatization). Child report of postinjury anxiety and injury perception were measured with the State-Trait Anxiety Inventory for Children and Children's Illness Perception Questionnaire. Psychological instrument scores were compared between those with and without delayed symptom resolution via a Kruskal-Wallis test. Associations between psychological traits and delayed symptom resolution were investigated by the use of logistic regression.

Results: Delayed symptom resolution occurred in 21% of participants. Score distributions were significantly worse on the State-Trait Anxiety Inventory for Children (38 [IQR 33-40] vs 35 [IQR 31-39]; P = .04) and somatization subscale (1 [IQR 0-3] vs 1 [IQR 0-1]; P = .01) among children with delayed symptom resolution compared with children with early symptom resolution. Somatization was associated with delayed symptom resolution (aOR 1.35, 95% CI 1.08-1.69). The proportion of children with abnormal somatization scores was significantly greater in the delayed symptom resolution group (34.2%) than the early symptom resolution group (12.8%; P < .01). Other psychological measures were not different between groups.

Conclusion: Somatization is associated with delayed symptom resolution in this cohort of children with concussion. Postconcussive symptoms lasting at least 1 month may warrant referral to a neuropsychologist familiar with postconcussion care.

Keywords: anxiety; children; concussion; emergency department; mild traumatic brain injury; postconcussive syndrome; somatization.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Age Factors
  • Brain Concussion / psychology*
  • Child
  • Emotional Adjustment
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Mental Disorders / etiology*
  • Mental Disorders / psychology
  • Neuropsychological Tests
  • Recovery of Function
  • Time Factors