TOPLINE

Children with concussion reported more acute emotional symptoms (within 48 hours of injury) than those with mild orthopedic injury. Having four acute emotional symptoms was associated with higher odds of emotional dysfunction, particularly among younger children at 1 week and among older children at 3 months.

METHODOLOGY

• Researchers conducted a secondary analysis of data from a prospective longitudinal cohort study to examine the link between concussion and emotional symptoms, with mild orthopedic injury serving as the comparator, among children who presented within 48 hours of injury to five pediatric emergency departments across Canada.
• A total of 793 children were included: 509 sustained blunt head trauma and were included in the concussion group (mean age, 12.35 years; 59.33% boys) and 284 had an upper or lower extremity fracture, sprain, or strain and were included in the orthopedic injury group (mean age, 12.61 years; 54.58% boys).
• Acute emotional symptoms were assessed using the Acute Concussion Evaluation, which measured four emotion-related items: sadness, irritability, increased emotionality, and nervousness.
• Emotional functioning after injury was measured using reports from a parent and/or a child on three different instruments at 1 week, 3 months, and/or 6 months post-injury. The ratings for the child's emotional functioning before the injury were reported by the parent at the 1-week visit.

TAKEAWAY

• Acute emotional symptoms were more frequent after concussion than after orthopedic injury in both boys (incidence rate ratio [IRR], 1.37; P = .008) and girls (IRR, 2.12; P < .001).
• For children with four acute emotional symptoms, emotional functioning was substantially worse 3 months after concussion vs orthopedic injury among girls based on parent reports of emotional functioning on a health-related quality-of-life measure (Cohen's d = -1.10; 95% CI, -2.16 to -0.04), across ages.
• For younger children with four acute emotional symptoms, emotional functioning was substantially worse at 1 week after concussion based on child reports (Cohen's d = -1.05; 95% CI, -2.04 to -0.06), regardless of sex.
• In post hoc comparisons, children with four acute emotional symptoms after concussion had higher odds of clinically elevated emotional dysfunction than those with orthopedic injury, noted in younger children at 1 week (odds ratio [OR], 95.05; P = .031) and in older children at 3 months after concussion (OR, 468.43; P = .038).

IN PRACTICE

"Acute emotional symptoms assessed in the ED [emergency departments] predicted later emotional dysfunction after concussion. Early identification of emotional symptoms could help to identify children at risk for chronic emotional dysfunction following a concussion and inform clinical decision-making post-injury," the authors wrote.

SOURCE

The study was led by Michael A. Lee of the Ware Brain Lab and Center for Translational Research in Neuroimaging and Data Science at Georgia State University in Atlanta, and Heather A. Shepherd of the School of Occupational Therapy at Western University in London, Ontario, Canada. It was published online on September 03, 2026, in The Journal of Pediatrics.

LIMITATIONS

Enrollment rates were higher for concussion than for orthopedic injuries, which could lead to potential sampling bias. Pre-injury emotional functioning was evaluated using parents' ratings collected a week after the injury, which could introduce recall bias. The children's own ratings of their emotional functioning before the injury were not collected.

DISCLOSURES

The study was supported by the Canadian Institutes of Health Research, Ronald and Irene Ward Chair in Pediatric Brain Injury, CREST Dynamic – Multiscale and Multimodal Brain Mapping Across the Lifespan graduate research assistantship. Several authors reported receiving grants, consulting fees, research support, or royalties from various organizations, including the Canadian Institutes of Health Research, National Institutes of Health, Brain Canada Foundation, National Football League Scientific Advisory Board, Guilford Press, Cambridge University Press, and others. Multiple authors reported owning a private practice. One of the authors reported being the co-founder, Scientific Director, and a minority shareholder in 360 Concussion Care.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.