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. 2025 Mar 3;8(3):e251092.
doi: 10.1001/jamanetworkopen.2025.1092.

Optimal Recovery Following Pediatric Concussion

Miriam H Beauchamp  1   2 , Ken Tang  3 , Andrée-Anne Ledoux  4   5   6 , Ashley D Harris  7   8 , Kristina A Kowalski  9 , William R Craig  10 , Jocelyn Gravel  2   11 , Quynh Doan  12   13 , Stephen B Freedman  14   15 , Roger L Zemek  4   16 , Keith Owen Yeates  9   17   18 ; Pediatric Emergency Research Canada A-CAP Study Team
Collaborators, Affiliations

Optimal Recovery Following Pediatric Concussion

Miriam H Beauchamp et al. JAMA Netw Open. .

Abstract

Importance: Pediatric concussion affects millions and results in heterogeneous outcomes and recovery trajectories. Given favorable outcome for most children, it is useful to understand characteristics of positive outcome to promote full recovery in all children.

Objective: To document the timeframe of recovery to optimal functioning, defined comprehensively across motor-physical, cognitive, socioemotional, and resilience-support domains, after concussion among children ages 8 to 16 years.

Design, setting, and participants: For this prospective cohort study, children ages 8 to 16.99 years with a concussion or orthopedic injury (OI) were recruited between September 2016 and July 2019 from 5 Pediatric Emergency Research Canada emergency departments and assessed approximately 10 days, 3 months, and 6 months after their injury. Data were analyzed from January 29, 2024, to January 11, 2025.

Exposure: Concussion.

Main outcomes and measures: Participants completed self-report and direct assessment measures of postconcussive symptoms, physical activity and function, balance, cognitive function, quality of life, resilience, and social support. The main outcome was optimal functioning, which was derived from 11 variables and criteria indicative of absence of impairment and average or above functioning in each domain (overall score, 0-11; higher score indicates better function). A longitudinal, multivariable, cumulative probability ordinal regression model was fitted to examine factors associated with optimal functioning.

Results: A total of 967 children (median [IQR] age, 12.3 [10.5-14.3] years; 562 [58.1%] male) were enrolled, including 633 children with a concussion and 334 children with an OI. The median (IQR) optimal functioning scores for the OI group were 6.0 (4.0-8.0) at 10 days, 7.0 (5.0-9.0) at 3 months, and 7 (5.0-9.0) at 6 months, compared with 4.0 (2.0-6.0) at 10 days, 6.0 (4.0-9.0) at 3 months, and 7.0 (4.0-9.0) at 6 months in the concussion group. The 3 main variables (time, sex, and group) were significantly associated with optimal functioning, as were all 2-way interactions. Time was the strongest factor associated with optimal functioning (Wald χ258 = 485.11; P < .001), followed by group (Wald χ26 = 95.10; P < .001), and sex (Wald χ26 = 23.19; P < .001). At the 10-day follow-up, concussion was associated with lower optimal functioning than OI among females (odds ratio [OR], 0.24 [95% CI, 0.16-0.36]) and males (OR, 0.37 [95% CI, 0.26-0.53]). This difference persisted for females at 3 months (OR, 0.57 [95% CI, 0.35-0.93]) but not for males. Optimal functioning was comparable at 6 months.

Conclusions and relevance: In this prospective cohort study of children with concussion, achieving optimal functioning levels across physical, cognitive, socioemotional, and resilience domains took 3 months or more, especially for girls with concussion. Multiple domains of outcome need to be taken into account when considering full recovery and optimal function after pediatric concussion.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Beauchamp reported a Tier 2 Canada Research Chair in Pediatric Traumatic Brain Injury, royalties from Guilford Press, and serving as a board member for International Pediatric Brain Injury Society and International Brain Injury Association during the conduct of the study and grants from Canadian Institutes of Health Research (CIHR) and Canada Funds for Innovation outside the submitted work. Dr Tang reported receiving personal fees from the University of Calgary during the conduct of the study. Dr Ledoux reported receiving grants from University of Ottawa Brain and Mind Research Institute, Ontario Brain Institute, and CHEO Foundation and nonfinancial support from Mobio Interactive outside the submitted work. Dr Craig reported receiving a grant from the Women and Children's Health Research Institute during the conduct of the study. Dr Zemek reported receiving grants from CIHR, Ontario Neurotrauma Foundation, Physician Services Incorporated Foundation, CHEO Foundation, Ontario Brain Institute, National Football League, Ontario Ministry of Health, Public Health Agency of Canada, Health Canada, Parachute Canada, and Ontario SPOR Support Unit (paid to institution) and a Tier 1 Clinical Research Chair in Pediatric Concussion from University of Ottawa outside the submitted work and serving on the board of directors for North American Brain Injury Society and as a founding partner and a minority shareholder of 360 Concussion Care outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Partial Effect Plots From Multivariable Model Fit of the Associations Among Group, Time, and Sex With Optimal Functioning
The model was adjusted to age 12.28 years, White race, parent with a Bachelor's degree, 28th percentile material deprivation index, 42nd percentile social deprivation index, mechanism of injury associated with a fall, less than 1 week symptom duration for previous concussion or no previous concussions, no history of migraine, 7 preinjury cognitive Health and Behavior Inventory items, and 1 preinjury somatic Health and Behavior Inventory item.
See this image and copyright information in PMC

References

    1. Beauchamp MH, Dégeilh F, Rose SC. Improving outcome after paediatric concussion: challenges and possibilities. Lancet Child Adolesc Health. 2023;7(10):728-740. doi:10.1016/S2352-4642(23)00193-1 - DOI - PubMed
    1. Chandler MC, Bloom J, Fonseca J, et al. . Quality of life differences in children and adolescents with 0, 1 to 2, or 3+ persistent postconcussion symptoms. J Athl Train. 2023;58(9):767-774. doi:10.4085/1062-6050-0552.22 - DOI - PMC - PubMed
    1. Gornall A, Takagi M, Clarke C, et al. . Psychological predictors of mental health difficulties after pediatric concussion. J Neurotrauma. 2024;41(13-14):e1639-e1648. doi:10.1089/neu.2023.0116 - DOI - PubMed
    1. Novak Z, Aglipay M, Barrowman N, et al. ; Pediatric Emergency Research Canada Predicting Persistent Postconcussive Problems in Pediatrics (PERC 5P) Concussion Team . Association of persistent postconcussion symptoms with pediatric quality of life. JAMA Pediatr. 2016;170(12):e162900. doi:10.1001/jamapediatrics.2016.2900 - DOI - PubMed
    1. Roberts J, Wilson JC, Halstead ME, et al. . Variables associated with days of school missed following concussion: results from the Sport Concussion Outcomes in PEdiatrics (SCOPE) study. Phys Sportsmed. 2024;52(6):592-600. doi:10.1080/00913847.2024.2344435 - DOI - PMC - PubMed

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