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J Neurotrauma. 2019 Mar 1;36(5):679-685. doi: 10.1089/neu.2018.5792. Epub 2018 Oct 10.

Predicting Psychological Distress after Pediatric Concussion.

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1 Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
2 Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada.
3 Faculty Saint-Jean, University of Alberta, Edmonton, Alberta, Canada.
4 Department of Psychology, University of Montreal & Ste-Justine Hospital Research Center, Montreal, Quebec, Canada.
5 Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
6 Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Calgary, Alberta, Canada.
7 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
8 Children's Hospital of Eastern Ontario Research Institute, Behavioral Neurosciences & Consultation-Liaison Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
9 Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.


A significant proportion of children and adolescents report psychological distress following concussion, but little is known about the predictors of these problems. The purpose of this study was to examine predictive factors of psychological distress following pediatric concussion. It was hypothesized that the presence of pre-injury psychological distress would be the strongest predictor of psychological distress post-concussion, with other demographic and acute injury factors adding incrementally to prediction. This is a prospective, multi-center cohort. Children and adolescents (6-17 years old; n = 311) who sustained a concussion and were assessed through four pediatric emergency departments. Participants were reassessed at 4-weeks (n = 275) and 12-weeks (n = 190) post-injury. Emergency department (ED) assessment documented injury mechanism, acute symptomatology, acute cognitive functioning, and pre-injury functioning. Psychological distress at 4- and 12-weeks follow-up was categorized as present if one or more psychological scores from the parent-completed measures (Child Behavior Checklist, Strengths and Difficulties Questionnaire) exceeded established cutoffs. The presence of psychological distress at each follow-up was predicted using multi-variable logistic regressions. Psychological distress was reported in 23% of youth at both 4- and 12-weeks post-concussion. A pre-injury diagnosis of anxiety and acutely forgetting recent information were significant predictors of psychological distress at 4 weeks, whereas worse acute orientation assessment in the ED predicted psychological distress at 12 weeks. Nearly one of four youth experienced psychological distress after concussion. Clinicians in acute care settings should screen for the factors (pre-injury anxiety, acute mental status) associated with post-injury psychological distress and consider proactively referring patients for further assistance.


adolescents; anxiety; children; depression; mTBI


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