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Clinicians face the dual challenge of low PSaC rates and nonspecific symptom rating even among uninjured peers, making accurate prognosis especially challenging. We used machine learning in a large prospective pmTBI cohort (\n                    <jats:italic toggle=\"yes\">N<\/jats:italic>\n                    = 321) to identify indicators of poor recovery at 4 months and 1-year postinjury. Participants completed comprehensive assessments within 11 days of injury that spanned multiple domains including demographics, injury-related factors, child and parent symptom ratings, cognitive tasks, objective performance, and symptom provocation on neurosensory tasks. Variable importance scores and 90% confidence intervals from 150 bootstraps were used to identify the best-performing assessments within each domain and then integrated into a combined model to assess overall prognostic value. Key findings suggest that retrospective self-report of symptom burden and vulnerability to symptom provocation were the most robust predictors of PSaC at both 4 months and 1-year postinjury, outperforming established risk scores. Other important measures included near point convergence, long-term memory, household size, and parental report of child symptom burden. Retrospective symptom burden and acute symptom provocation during simple tasks alongside established risk scores hold promise for improving early risk stratification and guiding individualized care. Additional research is needed to determine how to best integrate these measures into clinical workflows and validate their utility across diverse settings.\n                  <\/jats:p>","DOI":"10.1177\/08977151261442218","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T07:40:47Z","timestamp":1776411647000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Predictors of Long-Term Outcomes in Pediatric \u201cMild\u201d Traumatic Brain Injury: A Machine Learning Approach"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4467-8369","authenticated-orcid":false,"given":"Upasana","family":"Nathaniel","sequence":"first","affiliation":[{"name":"The Mind Research Network\/Lovelace Biomedical Research Institute, Albuquerque, New Mexico, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik 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Alberta, Canada."},{"name":"Alberta Children\u2019s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada."},{"name":"Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina L.","family":"Master","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy B.","family":"Meier","sequence":"additional","affiliation":[{"name":"Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA."},{"name":"Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA."},{"name":"Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harm J.","family":"van der Horn","sequence":"additional","affiliation":[{"name":"The Mind Research Network\/Lovelace Biomedical Research Institute, Albuquerque, New Mexico, USA."},{"name":"University of Groningen, University Medical Center Groningen, Groningen, the Netherlands."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davin K.","family":"Quinn","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioral Science, University of New Mexico, Albuquerque, New Mexico, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William A.","family":"Davis","sequence":"additional","affiliation":[{"name":"Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John P.","family":"Phillips","sequence":"additional","affiliation":[{"name":"The Mind Research Network\/Lovelace Biomedical 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