Researchers at Nationwide Children’s Hospital say classifying level of concussion may lead to better long-term outcomes.

1. Longitudinal Trajectories of Postconcussive Symptoms in
Children with Mild Traumatic Brain Injuries and Their
Relationships to Acute Clinical Status
*Research published in 2009 (123) Pediatrics.
Introduction • Children with MTBI were more likely to demonstrate
Mild traumatic brain injuries (MTBIs), also commonly high acute/resolved and high acute/persistent
referred to as concussions, are a very common medi- trajectories compared to children with orthopedic
cal problem for children and adolescents. MTBIs often injury.
result in postconcussive symptoms. Postconcussive • The two trajectories with high acute levels of post
symptoms include somatic, emotional, and cognitive concussive symptoms were likely among children
complaints, such as headaches, fatigue, irritability, and with MTBIs whose acute clinical presentation
difficulties with memory and attention. reflected more severe injury.
This is the first prospective, longitudinal study of post- • Physicians should monitor children with MTBIs,
concussive symptoms in children that defined MTBIs to identify those who display acute and persistent
across a range of injury severity, including “compli- increases in postconcussive symptoms. Appropriate
cated” MTBIs (i.e., those with acute indications of more interventions may alleviate postconcussive symptoms
severe brain injury). The study examined trajectories of when they do occur.
postconcussive symptoms across the first year follow-
ing injury in 8-15 year-old children with MTBIs and Research Method
children with orthopedic injuries. Results indicate that • Sample consisted of 8- to 15-year-old children
acute increases in postconcussive symptoms and persis- (186 with MTBIs; 99 with mild orthopedic injuries).
tent postconcussive symptoms are more likely to occur Children were recruited from consecutive
after MTBIs than orthopedic injuries, and especially so admissions to emergency departments at two large
after complicated MTBIs. children’s hospitals.
Children with MTBI were more likely than children • Parents rated current postconcussive symptoms
with orthopedic injury to belong to trajectories involv- within 3 weeks of injury and at 1, 3 and 12 months
ing high acute/persistent symptoms and high acute/ after injury. Parents also reported retrospective
resolved symptoms. Children whose MTBIs were asso- ratings of pre-injury symptoms.
ciated with indicators of more severe brain injury were • Children with MTBIs completed an MRI of the brain.
especially likely to demonstrate high acute levels of
postconcussive symptoms, as well as persistent symp- • Predictors of postconcussive symptoms included:
toms over time. – Loss of consciousness
– Glasgow Coma Scale score below 15
The study’s findings help to address the ongoing
debate on whether and why postconcussive symptoms – Associated injuries
continue over time following MTBIs in children and – Acute signs and symptoms of concussion
adolescents. (e.g., persistent post-traumatic amnesia)
Key Findings from Study – Intracranial abnormalities on MRI
• Children with MTBI and those with orthopedic
For more information, please contact the
injury demonstrated different distributions of
Center for Biobehavioral Health in The
symptom trajectories.
Research Institute at Nationwide Children’s
Hospital at 614-722-3182
www.NationwideChildrens.org/Research
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