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

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 postinjury emotional functioning were measured using 3 standardized and validated parent and child report questionnaires at 1 week (postacutely), 3 months, and 6 months postinjury. 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 3051 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 (incident rate ratio= 1.37) and especially females (incident rate ratio= 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 postinjury (postacutely) in younger children (d = -1.05), 3 months postinjury in females (d = -1.10), and across sex (d = 0.67). In the post hoc follow-up analyses, odds of clinically elevated emotional dysfunction were higher after concussion vs OI 1-week postinjury for younger children (OR = 95.05, 95% CI 1.53, 5900) and 3 months postinjury 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 postinjury. Acute emotional symptom screening may identify at-risk children. TRIAL REGISTRATION: Not applicable.