{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:02:40Z","timestamp":1792188160206,"version":"4.4.0"},"reference-count":55,"publisher":"SAGE Publications","issue":"21-22","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:p>\n                    This study sought to identify trajectories of symptom status in children and adolescents with concussion across the first 6 months post-injury and to examine their biopsychosocial correlates. The study used data collected as part of a prospective, longitudinal cohort study, Advancing Concussion Assessment in Pediatrics (A-CAP), conducted from 2016 to 2019, which recruited 967 English- or French-speaking children 8.0 to &lt;17 years old with either a concussion (\n                    <jats:italic toggle=\"yes\">N<\/jats:italic>\n                    = 633) or mild orthopedic injury (OI;\n                    <jats:italic toggle=\"yes\">N<\/jats:italic>\n                    = 334) from five pediatric emergency departments (EDs) in Canada. Participants rated post-injury symptoms weekly from 1 week to 3 months and biweekly from 3 to 6 months post-injury. The ratings of children with concussion were classified as symptomatic\/asymptomatic relative to retrospective pre-injury symptom ratings using reliable change equations derived from the OI group. A set of 26 biopsychosocial variables, assessed in the ED or at a 1-week visit, was derived from core measures collected in the A-CAP study. They were grouped\n                    <jats:italic toggle=\"yes\">a priori<\/jats:italic>\n                    into clusters of five to seven variables representing four domains (i.e., social determinants of health [SDoH], neurobiological, child psychosocial, and parent\/family psychosocial). Symptom trajectories were examined using latent class growth analysis (LCGA). Multinomial logistic regression tested the independent and joint ability of the variables in the four domains to discriminate trajectories. Multiple imputation with chained equations was completed prior to multivariable analyses. Analyses included children with concussion with \u22651 post-injury symptom rating (\n                    <jats:italic toggle=\"yes\">N<\/jats:italic>\n                    = 553; age\n                    <jats:italic toggle=\"yes\">m<\/jats:italic>\n                    = 12.4 years, standard deviation = 2.5; 40.3% female). Based on multiple statistical criteria, as well as parsimony and interpretability, LCGA identified four distinct symptom trajectories: rapid recovery (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 301, 54%); typical recovery (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 106, 19%); slow recovery (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 73, 13%); and chronically symptomatic (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 73, 13%). Variables in the SDoH, neurobiological, and child psychosocial domains independently discriminated the trajectories (polytomous discrimination index [PDI] = 0.39\u20130.44). When combined, significant variables from those three domains showed the best overall discrimination (PDI = 0.49). The findings indicate that children with concussion display distinct symptom trajectories that differ on SDoH, neurobiological, and psychosocial variables, confirming that a biopsychosocial model is critical to understanding pediatric concussion recovery and guiding its management. The findings may inform clinical prognosis and suggest potential targets for clinical trials, including post-acute pain and loneliness, to reduce persisting symptoms after concussion.\n                  <\/jats:p>","DOI":"10.1177\/08977151251365530","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T16:19:45Z","timestamp":1763396385000},"page":"1948-1962","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Symptom Trajectories and Their Biopsychosocial Correlates in Pediatric Concussion: An A-CAP Study"],"prefix":"10.1177","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7680-2892","authenticated-orcid":false,"given":"Keith Owen","family":"Yeates","sequence":"first","affiliation":[{"name":"Department of Psychology, Alberta Children\u2019s Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Tang","sequence":"additional","affiliation":[{"name":"Independent Statistical Consulting, Vancouver, British Columbia, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherri","family":"Zhang","sequence":"additional","affiliation":[{"name":"Institute for Global Health, BC Children\u2019s and Women\u2019s Hospital, Vancouver, British Columbia, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam H.","family":"Beauchamp","sequence":"additional","affiliation":[{"name":"Department of Psychology, Universit\u00e9 de Montr\u00e9al and CHU Sainte-Justine Azrieli Research Center, Montr\u00e9al, Quebec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R.","family":"Craig","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Alberta and Stollery Children\u2019s Hospital, Edmonton, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quynh","family":"Doan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of British Columbia and BC Children\u2019s Hospital Research Institute, Vancouver, British Columbia, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen B.","family":"Freedman","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"Gravel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency Medicine, CHU Sainte-Justine Hospital Research Center, and Department of Pediatrics, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, Quebec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8390-4915","authenticated-orcid":false,"given":"Ashley L.","family":"Ware","sequence":"additional","affiliation":[{"name":"Department of Psychology, Georgia State University, Atlanta, Georgia, USA."},{"name":"Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger L.","family":"Zemek","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine, University of Ottawa and Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Pediatric Emergency Research Canada (PERC) A-CAP Study Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2016.03.045"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.3820"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2022.03.039"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/HTR.0000000000000878"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyaa310"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-1056"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(23)00193-1"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017012"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000001360"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/16501960410023877"},{"key":"e_1_3_2_13_2","volume-title":"The Abbreviated Injury Scale (AIS)-1990 Revision. 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