BACKGROUND: Mild traumatic brain injury (mTBI), including concussion, is common and has received a great deal of attention, but terminology and diagnosis can be confusing. Postconcussive symptoms (PCS) are well-described in the setting of concussion and isolated mTBI, but the individual symptoms are nonspecific and may be present in patients with extracranial injuries without TBI. The time course of PCS has not been well-characterized in patients with extracranial trauma, either with or without concomitant mTBI. We hypothesized that patients with mTBI with moderate/severe extracranial trauma would experience a unique, more severe and longer-lasting pattern of PCS with more negative impact on quality of life (QOL) when compared with similar trauma patients without mTBI. METHODS: Prospective multicenter study (2018–2024) of patients aged 5 to 17 with extracranial Injury Severity Score >8, excluding moderate/severe TBI. Patients with and without mTBI (GCS 13–15, alteration of mental status or other signs/symptoms of TBI) were included. Patients were assessed at 1 week, 3 weeks, and 3 months with the Rivermead PCS Inventory and PedsQL QOL assessments. RESULTS: One hundred thirty-four patients were included: 53 (40%) had mTBI. Adolescent mTBI patients had significantly higher PCS Inventory scores than non-mTBI adolescents at T1 and T2. Symptoms persisted in >25% of both groups at T3. The QOL was impacted by the PCS burden. CONCLUSIONS: Although attrition compromised the statistical power of the study, many patients with moderate/severe extracranial trauma have a significant PCS burden at 3 months postinjury. Those with mTBI have a greater symptom burden and unique symptomatology compared with those without mTBI. Attention to diagnosis and treatment of mTBI and support and anticipatory guidance for all pediatric moderate/severe trauma patients is warranted. ( J Trauma Acute Care Surg 2026;00:000–000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.) LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.
Biffl et al. (Mon,) studied this question.