{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:11:14Z","timestamp":1792725074650,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Research on postconcussive symptoms (PCS) following early childhood concussion has been hindered by a lack of measures suitable for this age group, resulting in a limited understanding of their evolution in young children.<\/jats:p><\/jats:sec>Objective<\/jats:title>To document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used data collected at 3 Canadian and 1 US urban pediatric emergency departments (EDs) and 8 Canadian daycares from December 2018 to December 2022 as part of the Kids\u2019 Outcomes and Long-Term Abilities (KOALA) project, a prospective, multicenter, longitudinal cohort study. Participants included children aged 6 to 72 months with early childhood concussion or orthopedic injury (OI) or uninjured children from the community to serve as controls. Data were analyzed from March 2023 to January 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Concussion sustained between ages 6 and 72 months.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Primary outcomes were cognitive, physical, behavioral and total PCS assessed prior to injury (retrospectively), acutely (within 48 hours), and at 10 days, 1 month, and 3 months after injury or recruitment through caregiver observations using the Report of Early Childhood Traumatic Injury Observations &amp;amp; Symptoms inventory. Group comparisons were analyzed using ordinal regression models.<\/jats:p><\/jats:sec>Results<\/jats:title>The study included 303 children (mean [SD] age, 35.8 [20.2] months; 152 [50.2%] male). Of these, 174 children had a concussion (mean [SD] age, \u200933.3 [19.9] months), 60 children had an OI (mean [SD] age, 38.4 [19.8] months) and 69 children were uninjured controls (mean [SD] age, 39.7 [20.8] months). No meaningful differences were found between the concussion and comparison groups in retrospective preinjury PCS. Significant group differences were found for total PCS at the initial ED visit (concussion vs OI: odds ratio [OR], 4.33 [95% CI, 2.44-7.69]; concussion vs control: OR, 7.28 [95% CI, 3.80-13.93]), 10 days (concussion vs OI: OR, 4.44 [95% CI, 2.17-9.06]; concussion vs control: OR, 5.94 [95% CI, 3.22-10.94]), 1 month (concussion vs OI: OR, 2.70 [95% CI, 1.56-4.68]; concussion vs control: OR, 4.32 [95% CI, 2.36-7.92]), and 3 months (concussion vs OI: OR, 2.61 [95% CI, 1.30-5.25]; concussion vs control: OR, 2.40 [95% CI, 1.36-4.24]). Significant group differences were also found for domain-level scores (cognitive, physical, behavioral) at various time points.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this early childhood cohort study, concussion was associated with more PCS than OIs or typical development up to 3 months after injury. Given the limited verbal and cognitive abilities typical of early childhood, using developmentally appropriate manifestations and behaviors is a valuable way of tracking PCS and could aid in concussion diagnosis in young children.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.3182","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T15:01:32Z","timestamp":1711033292000},"page":"e243182","source":"Crossref","is-referenced-by-count":16,"title":["Postconcussive Symptoms After Early Childhood Concussion"],"prefix":"10.1001","volume":"7","author":[{"given":"Dominique","family":"Dupont","sequence":"first","affiliation":[{"name":"Department of Psychology, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"},{"name":"Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Tang","sequence":"additional","affiliation":[{"name":"Independent Statistical Consultant, Richmond, British Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Beaudoin","sequence":"additional","affiliation":[{"name":"Department of Psychology, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"},{"name":"Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanny","family":"D\u00e9geilh","sequence":"additional","affiliation":[{"name":"Univ Rennes, CNRS (Centre national de recherche scientifique), Inria, Inserm, IRISA (Institut de recherche en informatique et syst\u00e8mes al\u00e9atoires) UMR (Unit\u00e9 mixte de recherche) 6074, EMPENN \u2014 ERL (Equipe de recherche labellis\u00e9e) U1228, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Gagnon","sequence":"additional","affiliation":[{"name":"Montreal Children\u2019s Hospital, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith Owen","family":"Yeates","sequence":"additional","affiliation":[{"name":"Hotchkiss Brain Institute, Alberta Children\u2019s Hospital Research Institute, Calgary, Alberta, Canada"},{"name":"Department of Psychology, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean C.","family":"Rose","sequence":"additional","affiliation":[{"name":"Child Neurology, Nationwide Children\u2019s Hospital, Columbus, Ohio"},{"name":"The Ohio State University College of Medicine Columbus, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"Gravel","sequence":"additional","affiliation":[{"name":"Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Burstein","sequence":"additional","affiliation":[{"name":"Montreal Children\u2019s Hospital, Division of Pediatric Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia S.","family":"Stang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Calgary, Calgary Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M.","family":"Stanley","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Medicine Columbus, Columbus"},{"name":"Emergency Medicine, Nationwide Children\u2019s Hospital, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger L.","family":"Zemek","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam H.","family":"Beauchamp","sequence":"additional","affiliation":[{"name":"Department of Psychology, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"},{"name":"Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"PERC KOALA Study","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Bernier","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Lebel","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramy","family":"El-Jalbout","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Lupien","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"de Beaumont","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Dehaes","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Cohen","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"McLellan-Lamarche","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa Marie","family":"Langevin","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Mazza","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylour","family":"Aungst","sequence":"additional","affiliation":[{"name":"for the PERC KOALA Study"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"issue":"9","key":"zoi240139r1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss6609a1","article-title":"Traumatic brain injury\u2013related emergency department visits, hospitalizations, and deaths\u2014United States, 2007 and 2013.","volume":"66","author":"Taylor","year":"2017","journal-title":"MMWR Surveill Summ"},{"key":"zoi240139r2","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.jsr.2019.06.003","article-title":"Fall-related traumatic brain injury in children ages 0-4 years.","volume":"70","author":"Haarbauer-Krupa","year":"2019","journal-title":"J Safety Res"},{"key":"zoi240139r3","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.ajem.2022.12.035","article-title":"Emergency department visits for mild traumatic brain injury in early childhood.","volume":"65","author":"Rose","year":"2023","journal-title":"Am J Emerg Med"},{"issue":"2","key":"zoi240139r4","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1037\/a0018112","article-title":"Post-concussive symptoms in children with mild traumatic brain injury.","volume":"24","author":"Taylor","year":"2010","journal-title":"Neuropsychology"},{"key":"zoi240139r5","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.3389\/fneur.2018.01113","article-title":"A multidimensional approach to post-concussion symptoms in mild traumatic brain injury.","volume":"9","author":"Polinder","year":"2018","journal-title":"Front Neurol"},{"issue":"1","key":"zoi240139r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.3820","article-title":"Natural progression of symptom change and recovery from concussion in a pediatric population.","volume":"173","author":"Ledoux","year":"2019","journal-title":"JAMA Pediatr"},{"issue":"10","key":"zoi240139r7","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1001\/jama.2016.1203","article-title":"Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED.","volume":"315","author":"Zemek","year":"2016","journal-title":"JAMA"},{"key":"zoi240139r8","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jpeds.2022.03.039","article-title":"Classification criteria and rates of persistent postconcussive symptoms in children: a systematic review and meta-analysis.","volume":"246","author":"Chadwick","year":"2022","journal-title":"J Pediatr"},{"issue":"12","key":"zoi240139r9","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2016.2900","article-title":"Association of persistent postconcussion symptoms with pediatric quality of life.","volume":"170","author":"Novak","year":"2016","journal-title":"JAMA Pediatr"},{"issue":"7","key":"zoi240139r10","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1001\/archpediatrics.2011.1082","article-title":"Reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury.","volume":"166","author":"Yeates","year":"2012","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"12","key":"zoi240139r11","doi-asserted-by":"publisher","first-page":"e1652","DOI":"10.1097\/PEC.0000000000002148","article-title":"Characteristics of diagnosed concussions in children aged 0 to 4 years presenting to a large pediatric healthcare network.","volume":"37","author":"Podolak","year":"2021","journal-title":"Pediatr Emerg Care"},{"issue":"1","key":"zoi240139r12","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1111\/jnp.v14.1","article-title":"Factors contributing to parent-child interaction quality following mild traumatic brain injury in early childhood.","volume":"14","author":"Lalonde","year":"2020","journal-title":"J Neuropsychol"},{"issue":"3","key":"zoi240139r13","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1097\/HTR.0b013e3182a2dd7f","article-title":"A comparison of concussive symptoms reported by parents for preschool versus school-aged children.","volume":"29","author":"McKinlay","year":"2014","journal-title":"J Head Trauma Rehabil"},{"issue":"11","key":"zoi240139r14","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.1080\/02699052.2017.1350999","article-title":"Acute post-concussive symptoms in young children.","volume":"31","author":"Bernard","year":"2017","journal-title":"Brain Inj"},{"issue":"5","key":"zoi240139r15","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1080\/17518423.2023.2242945","article-title":"Post-concussive symptoms in preschool children up to three months post-injury.","volume":"26","author":"Yumul","year":"2023","journal-title":"Dev Neurorehabil"},{"issue":"3","key":"zoi240139r16","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1177\/1367493509336691","article-title":"The specificity of post-concussive symptoms in the pediatric population.","volume":"13","author":"Falk","year":"2009","journal-title":"J Child Health Care"},{"issue":"1","key":"zoi240139r17","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3233\/PRM-160424","article-title":"Caregiver-report of symptoms following traumatic brain injury in a small clinical sample of preschool-aged children.","volume":"11","author":"Suskauer","year":"2018","journal-title":"J Pediatr Rehabil Med"},{"issue":"3","key":"zoi240139r18","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1007\/s11065-021-09518-z","article-title":"Post-concussive signs and symptoms in preschool children: a systematic Review.","volume":"32","author":"Yumul","year":"2022","journal-title":"Neuropsychol Rev"},{"issue":"2","key":"zoi240139r19","doi-asserted-by":"publisher","first-page":"E102","DOI":"10.1097\/HTR.0000000000000691","article-title":"Report of early childhood traumatic injury observations & symptoms: preliminary validation of an observational measure of postconcussive symptoms.","volume":"37","author":"Dupont","year":"2022","journal-title":"J Head Trauma Rehabil"},{"issue":"10","key":"zoi240139r20","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-040603","article-title":"Kids\u2019 Outcomes And Long-term Abilities (KOALA): protocol for a prospective, longitudinal cohort study of mild traumatic brain injury in children 6 months to 6 years of age.","volume":"10","author":"Beauchamp","year":"2020","journal-title":"BMJ Open"},{"key":"zoi240139r21","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.961024","article-title":"Social determinants of participant recruitment and retention in a prospective cohort study of pediatric mild traumatic brain injury.","volume":"13","author":"Wells","year":"2022","journal-title":"Front Neurol"},{"key":"zoi240139r22","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-0072.23","article-title":"Systematic Review Examining the Reporting of Race and Ethnicity in Sport-Related Concussion Studies.","author":"Jo","year":"2023","journal-title":"J Athl Train"},{"issue":"2","key":"zoi240139r23","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support.","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"issue":"12","key":"zoi240139r24","doi-asserted-by":"publisher","first-page":"1392","DOI":"10.1089\/neu.2019.6683","article-title":"Trajectories and predictors of clinician-determined recovery after child concussion.","volume":"37","author":"Anderson","year":"2020","journal-title":"J Neurotrauma"},{"issue":"6","key":"zoi240139r25","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1097\/HTR.0000000000000298","article-title":"Do concussive symptoms really resolve in young children?","volume":"32","author":"Bernard","year":"2017","journal-title":"J Head Trauma Rehabil"},{"issue":"6","key":"zoi240139r26","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1017\/S1355617710000986","article-title":"Mild traumatic brain injury and postconcussive symptoms in children and adolescents.","volume":"16","author":"Yeates","year":"2010","journal-title":"J Int Neuropsychol Soc"},{"issue":"3","key":"zoi240139r27","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1017\/S1355617711001895","article-title":"A comparison of long-term postconcussive symptoms between university students with and without a history of mild traumatic brain injury or orthopedic injury.","volume":"18","author":"Ettenhofer","year":"2012","journal-title":"J Int Neuropsychol Soc"},{"issue":"7-8","key":"zoi240139r28","doi-asserted-by":"publisher","first-page":"887","DOI":"10.3109\/02699052.2013.793398","article-title":"Community versus orthopaedic controls in traumatic brain injury research: how comparable are they?","volume":"27","author":"Mathias","year":"2013","journal-title":"Brain Inj"},{"issue":"10","key":"zoi240139r29","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1097\/BOT.0000000000001276","article-title":"Sleep disturbance in orthopaedic trauma patients.","volume":"32","author":"Swann","year":"2018","journal-title":"J Orthop Trauma"},{"issue":"1","key":"zoi240139r30","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1097\/JTN.0000000000000557","article-title":"Anxiety symptoms after orthopedic injury: a systematic review.","volume":"28","author":"Breazeale","year":"2021","journal-title":"J Trauma Nurs"},{"issue":"9","key":"zoi240139r31","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1016\/j.pmrj.2015.03.007","article-title":"Psychological distress after orthopedic trauma: prevalence in patients and implications for rehabilitation.","volume":"7","author":"Vincent","year":"2015","journal-title":"PM R"},{"issue":"3","key":"zoi240139r32","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1542\/peds.2008-1056","article-title":"Longitudinal trajectories of postconcussive symptoms in children with mild traumatic brain injuries and their relationship to acute clinical status.","volume":"123","author":"Yeates","year":"2009","journal-title":"Pediatrics"},{"issue":"2","key":"zoi240139r33","doi-asserted-by":"publisher","first-page":"e374","DOI":"10.1542\/peds.2009-0925","article-title":"Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury.","volume":"126","author":"Barlow","year":"2010","journal-title":"Pediatrics"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2816596\/dupont_2024_oi_240139_1710422807.75622.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T15:01:36Z","timestamp":1711033296000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2816596"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,21]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3,4]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.3182","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,21]]}}}