title: Psychological Factors Associated with Delayed Symptom Resolution in Children with Concussion.
abstract: To characterize the psychological factors associated with persistent symptoms after pediatric concussion.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO. Electronic address: Joe.grubenhoff@childrenscolorado.org.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Grubenhoff
authors.affiliation: Colorado School of Public Health, Aurora, CO.
authors.forename: Dustin
authors.initials: D
authors.lastname: Currie
authors.affiliation: Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Colorado School of Public Health, Aurora, CO.
authors.forename: R Dawn
authors.initials: RD
authors.lastname: Comstock
authors.affiliation: Colorado School of Public Health, Aurora, CO.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Juarez-Colunga
authors.affiliation: Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO.
authors.forename: Lalit
authors.initials: L
authors.lastname: Bajaj
authors.affiliation: Children's Hospital Colorado, Aurora, CO; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kirkwood
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001924:Brain Concussion / Q000523:psychology*; D002648:Child; D000066498:Emotional Adjustment; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000523:psychology; D009483:Neuropsychological Tests; D020127:Recovery of Function; D013997:Time Factors
keywords: anxiety; children; concussion; emergency department; mild traumatic brain injury; postconcussive syndrome; somatization