title: History of Somatization Is Associated with Prolonged Recovery from Concussion.
abstract: OBJECTIVE
  To determine the association between a history of somatization and prolonged concussion symptoms, including sex differences in recovery.
  
  
  METHODS
  A prospective cohort study of 10- to 18-year-olds with an acute concussion was conducted from July 2014 to April 2015 at a tertiary care pediatric emergency department. One hundred twenty subjects completed the validated Children's Somatization Inventory (CSI) for pre-injury somatization assessment and Postconcussion Symptoms Scale (PCSS) at diagnosis. PCSS was re-assessed by phone at 2 and 4 weeks. CSI was assessed in quartiles with a generalized estimating equation model to determine relationship of CSI to PCSS over time.
  
  
  RESULTS
  The median age of our study participants was 13.8 years (IQR 11.5, 15.8), 60% male, with separate analyses for each sex. Our model showed a positive interaction between total CSI score, PCSS and time from concussion for females P < .01, and a statistical trend for males, P = .058. Females in the highest quartile of somatization had higher PCSS than the other 3 CSI quartiles at each time point (B -26.7 to -41.1, P values <.015).
  
  
  CONCLUSIONS
  Patients with higher pre-injury somatization had higher concussion symptom scores over time. Females in the highest somatization quartile had prolonged concussion recovery with persistently high symptom scores at 4 weeks. Somatization may contribute to sex differences in recovery, and assessment at the time of concussion may help guide management and target therapy.
authors.affiliation: Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC. Electronic address: jroot@childrensnational.org.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Root
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: Noel S
authors.initials: NS
authors.lastname: Zuckerbraun
authors.affiliation: Office of Clinical Research, Health Sciences, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Office of Clinical Research, Health Sciences, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Winger
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: David
authors.initials: D
authors.lastname: Brent
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Kontos
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Hickey
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000150:complications / Q000523:psychology*; D011446:Prospective Studies; D020127:Recovery of Function; D012737:Sex Factors; D013001:Somatoform Disorders / Q000150:complications* / Q000523:psychology*; D013997:Time Factors
keywords: gender differences; prolonged concussion syndrome; somatization