{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:02:38Z","timestamp":1792188158564,"version":"4.4.0"},"reference-count":47,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,3,1]]},"abstract":"<jats:p>OBJECTIVE. We examined whether mild traumatic brain injuries in children and adolescents, especially when associated with acute clinical features reflecting more severe injury, result in different postinjury trajectories of postconcussive symptoms compared with mild orthopedic injuries.<\/jats:p>\n               <jats:p>PARTICIPANTS AND METHODS. Participants in this prospective and longitudinal cohort study were 8- to 15-year-old children, 186 with mild traumatic brain injuries and 99 with mild orthopedic injuries, who were recruited from consecutive admissions to emergency departments in 2 large children's hospitals. Parents rated current postconcussive symptoms within 3 weeks of injury and at 1, 3, and 12 months after injury. At the initial assessment, parents also provided retrospective ratings of preinjury symptoms, and children with mild traumatic brain injuries received MRI of the brain. Clinical features examined as predictors of postconcussive symptoms included loss of consciousness, Glasgow Coma Scale score below 15, other injuries, acute symptoms of concussion, and intracranial abnormalities on the MRI.<\/jats:p>\n               <jats:p>RESULTS. Finite mixture modeling identified 4 longitudinal trajectories of postconcussive symptoms (ie, no postconcussive symptoms, moderate persistent postconcussive symptoms, high acute\/resolved postconcussive symptoms, high acute\/persistent postconcussive symptoms). The mild traumatic brain injuries and orthopedic injuries groups demonstrated a different distribution of trajectories. Children with mild traumatic brain injuries were more likely than those with orthopedic injuries to demonstrate high acute\/resolved and high acute\/persistent trajectories relative to the no postconcussive symptoms group. The 2 trajectories with high acute levels of postconcussive symptoms were especially likely among children with mild traumatic brain injuries whose acute clinical presentation reflected more severe injury.<\/jats:p>\n               <jats:p>CONCLUSIONS. Mild traumatic brain injuries, particularly those that are more severe, are more likely than orthopedic injuries to result in transient or persistent increases in postconcussive symptoms in the first year after injury. Additional research is needed to elucidate the range of factors, both injury related and non\u2013injury related, that place some children with mild traumatic brain injuries at risk for postconcussive symptoms.<\/jats:p>","DOI":"10.1542\/peds.2008-1056","type":"journal-article","created":{"date-parts":[[2009,3,2]],"date-time":"2009-03-02T12:49:02Z","timestamp":1235998142000},"page":"735-743","source":"Crossref","is-referenced-by-count":230,"title":["Longitudinal Trajectories of Postconcussive Symptoms in Children With Mild Traumatic Brain Injuries and Their Relationship to Acute Clinical Status"],"prefix":"10.1542","volume":"123","author":[{"given":"Keith Owen","family":"Yeates","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Ohio State University, Columbus, Ohio"},{"name":"Center for Biobehavioral Health, Research Institute at Nationwide Children's Hospital, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Gerry","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio"},{"name":"Rainbow Babies & Children's Hospital, Cleveland, Ohio; Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome","family":"Rusin","sequence":"additional","affiliation":[{"name":"Radiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Bangert","sequence":"additional","affiliation":[{"name":"Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ohio State University, Columbus, Ohio"},{"name":"Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Nuss","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ohio State University, Columbus, Ohio"},{"name":"Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio"},{"name":"Rainbow Babies & Children's Hospital, Cleveland, Ohio; Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Nagin","sequence":"additional","affiliation":[{"name":"Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobby L.","family":"Jones","sequence":"additional","affiliation":[{"name":"Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2009,3,1]]},"reference":[{"key":"2021120902464201000_R1","unstructured":"Kraus JF. Epidemiological features of brain injury in children: occurrence, children at risk, causes and manner of injury, severity, and outcomes. In: Broman SH, Michel ME, eds. Traumatic Head Injury in Children. New York, NY: Oxford University Press; 1995:22\u201339"},{"key":"2021120902464201000_R2","unstructured":"Yeates KO. Closed-head injury. In: Yeates KO, Ris, MD, Taylor HG, eds. Pediatric Neuropsychology: Research, Theory, and Practice. New York, NY: Guilford; 2000:92\u2013116"},{"key":"2021120902464201000_R3","doi-asserted-by":"crossref","unstructured":"Bazarian JJ, McClung J, Shah MN, et al. Mild traumatic brain injury in the United States, 1998\u20132000. Brain Inj.\u20082005;19(2):85\u201391","DOI":"10.1080\/02699050410001720158"},{"key":"2021120902464201000_R4","doi-asserted-by":"crossref","unstructured":"Carroll LJ, Cassidy JD, Peloso PM, et al. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med.\u20082004;43(suppl):84\u2013105","DOI":"10.1080\/16501960410023859"},{"key":"2021120902464201000_R5","doi-asserted-by":"crossref","unstructured":"Satz P. Mild head injury in children and adolescents. Curr Dir Psychol Sci.\u20082001;10(3):106\u2013109","DOI":"10.1111\/1467-8721.00127"},{"key":"2021120902464201000_R6","doi-asserted-by":"crossref","unstructured":"Satz P, Zaucha K, McCleary C, Light R, Asarnow R. Mild head injury in children and adolescents: a review of studies (1970\u20131995). Psychol Bull.\u20081997;122(2):107\u2013131","DOI":"10.1037\/0033-2909.122.2.107"},{"key":"2021120902464201000_R7","unstructured":"World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, Switzerland: World Health Organization; 1992"},{"key":"2021120902464201000_R8","unstructured":"American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994"},{"key":"2021120902464201000_R9","doi-asserted-by":"crossref","unstructured":"Farmer MY, Singer HS, Mellitis ED, Hall D, Charney E. Neurobehavioral sequelae of minor head injuries in children. Pediatr Neurosci.\u20081987;13(6):304\u2013308","DOI":"10.1159\/000120348"},{"key":"2021120902464201000_R10","doi-asserted-by":"crossref","unstructured":"Fay GC, Jaffe KM, Polissar NL, et al. Mild pediatric traumatic brain injury: a cohort study. Arch Phys Med Rehabil.\u20081993;74(9):895\u2013901","DOI":"10.1016\/0003-9993(93)90156-5"},{"key":"2021120902464201000_R11","doi-asserted-by":"crossref","unstructured":"Mittenberg W, Wittner MS, Miller LJ. Postconcussion syndrome occurs in children. Neuropsychology.\u20081997;11(3):447\u2013452","DOI":"10.1037\/0894-4105.11.3.447"},{"key":"2021120902464201000_R12","doi-asserted-by":"crossref","unstructured":"Ponsford J, Willmott C, Rothwell A, et al. Cognitive and behavioral outcomes following mild traumatic head injury in children. J Head Trauma Rehabil.\u20081999;14(4):360\u2013372","DOI":"10.1097\/00001199-199908000-00005"},{"key":"2021120902464201000_R13","doi-asserted-by":"crossref","unstructured":"Yeates KO, Luria J, Bartkowski H, et al. Post-concussive symptoms in children with mild closed-head injuries. J Head Trauma Rehabil.\u20081999;14(4):337\u2013350","DOI":"10.1097\/00001199-199908000-00003"},{"key":"2021120902464201000_R14","doi-asserted-by":"crossref","unstructured":"McKinlay A, Dalrymple-Alford JC, Horwood LJ, Fergusson DM. Long-term psychosocial outcomes after mild head injury in early childhood. J Neurol Neurosurg Psychiatry.\u20082002;73(3):281\u2013288","DOI":"10.1136\/jnnp.73.3.281"},{"key":"2021120902464201000_R15","doi-asserted-by":"crossref","unstructured":"Nacajauskaite O, Endziniene M, Jureniene K, Schrader H. The validity of post-concussion syndrome in children: a controlled historical cohort study. Brain Dev.\u20082006;28(8):507\u2013514","DOI":"10.1016\/j.braindev.2006.02.010"},{"key":"2021120902464201000_R16","unstructured":"Alexander MP. Minor traumatic brain injury: a review of physiogenesis and psychogenesis. Semin Clin Neuropsychiatry.\u20081997;2(3):177\u2013187"},{"key":"2021120902464201000_R17","doi-asserted-by":"crossref","unstructured":"Lishman WA. Physiogenesis and psychogenesis in the post-concussional syndrome. Br J Psychiatry.\u20081988;153:460\u2013469","DOI":"10.1192\/bjp.153.4.460"},{"key":"2021120902464201000_R18","doi-asserted-by":"crossref","unstructured":"Binder LM, Rohling ML, Larrabee GJ. A review of mild head trauma: part II. Clinical implications. J Clin Exp Neuropsychol.\u20081997;19(3):432\u2013457","DOI":"10.1080\/01688639708403871"},{"key":"2021120902464201000_R19","doi-asserted-by":"crossref","unstructured":"Gasquoine PG. Postconcussion symptoms. Neuropsychol Rev.\u20081997;7(2):77\u201385","DOI":"10.1023\/B:NERV.0000005945.58251.c0"},{"key":"2021120902464201000_R20","doi-asserted-by":"crossref","unstructured":"Elson LM, Ward CC. Mechanisms and pathophysiology of mild head injury. Semin Neurol.\u20081994;14(1):8\u201318","DOI":"10.1055\/s-2008-1041053"},{"key":"2021120902464201000_R21","unstructured":"Giza CC, Hovda DA. The neurometabolic cascade of concussion. J Athl Train.\u20082001;36(3):228\u2013235"},{"key":"2021120902464201000_R22","doi-asserted-by":"crossref","unstructured":"Levin HS, Amparo E, Eisenberg HM, et al. Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries. J Neurosurg.\u20081987;66(5):706\u2013713","DOI":"10.3171\/jns.1987.66.5.0706"},{"key":"2021120902464201000_R23","doi-asserted-by":"crossref","unstructured":"Leininger BE, Gramling SE, Farrell AD, Kreutzer JS, Peck E III. Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. J Neurol Neurosurg Psychiatry.\u20081990;53(4):293\u2013296","DOI":"10.1136\/jnnp.53.4.293"},{"key":"2021120902464201000_R24","doi-asserted-by":"crossref","unstructured":"Ruff RM, Crouch JA, Troster AI, et al. Selected cases of poor outcome following a minor brain trauma: comparing neuropsychological and positron emission tomography assessment. Brain Inj.\u20081994;8(4):297\u2013308","DOI":"10.3109\/02699059409150981"},{"key":"2021120902464201000_R25","doi-asserted-by":"crossref","unstructured":"Varney NR, Bushnell DL, Nathan M, et al. NeuroSPECT correlates of disabling mild head injury: preliminary findings. J Head Trauma Rehabil.\u20081995;10:18\u201328","DOI":"10.1097\/00001199-199510030-00003"},{"key":"2021120902464201000_R26","doi-asserted-by":"crossref","unstructured":"Dikman SS, Levin HS. Methodological issues in the study of mild head injury. J Head Trauma Rehabil.\u20081993;8(3):30\u201337","DOI":"10.1097\/00001199-199309000-00005"},{"key":"2021120902464201000_R27","doi-asserted-by":"crossref","unstructured":"Yeates KO, Taylor HG. Neurobehavioral outcomes of mild head injury in children and adolescents. Pediatr Rehabil.\u20082005;8(1):5\u201316","DOI":"10.1080\/13638490400011199"},{"key":"2021120902464201000_R28","doi-asserted-by":"crossref","unstructured":"Williams DH, Levin HS, Eisenberg HM. Mild head injury classification. Neurosurgery.\u20081990;27(3):422\u2013428","DOI":"10.1227\/00006123-199009000-00014"},{"key":"2021120902464201000_R29","doi-asserted-by":"crossref","unstructured":"Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet.\u20081974;2(7872):81\u201384","DOI":"10.1016\/S0140-6736(74)91639-0"},{"key":"2021120902464201000_R30","doi-asserted-by":"crossref","unstructured":"Falk A-C, Cederfja\u0308ll C, Von Wendt L, Klang B. Are the symptoms and severity of head injury predictive of clinical findings three months later?Acta Paediatr.\u20082006;95(12):1533\u20131539","DOI":"10.1080\/08035250600731957"},{"key":"2021120902464201000_R31","doi-asserted-by":"crossref","unstructured":"Levin HS, Hanten G, Roberson G, et al. Prediction of cognitive sequelae based on abnormal computed tomography findings in children following mild traumatic brain injury. J Neurosurg Pediatr.\u20082008;1(6):416\u2013470","DOI":"10.3171\/PED\/2008\/1\/6\/461"},{"key":"2021120902464201000_R32","doi-asserted-by":"crossref","unstructured":"Nagin DS. Analyzing developmental trajectories: a semi-parametric, group-based approach. Psychol Methods.\u20081999;4(2):129\u2013177","DOI":"10.1037\/1082-989X.4.2.139"},{"key":"2021120902464201000_R33","doi-asserted-by":"crossref","unstructured":"Nagin DS. Group-Based Modeling of Development. Cambridge, MA: Harvard University Press; 2005","DOI":"10.4159\/9780674041318"},{"key":"2021120902464201000_R34","unstructured":"American Association for Automotive Medicine. The Abbreviated Injury Scale (AIS): 1990 Revision. Des Plaines, IL: American Association for Automotive Medicine; 1990"},{"key":"2021120902464201000_R35","doi-asserted-by":"crossref","unstructured":"Mayer T, Matlak M, Johnson D, Walker M. The modified injury severity scale in pediatric multiple trauma patients. J Pediatr Surg.\u20081980;15(6):719\u2013726","DOI":"10.1016\/S0022-3468(80)80271-5"},{"key":"2021120902464201000_R36","doi-asserted-by":"crossref","unstructured":"Dunning J, Batchelor J, Stratford-Smith P, et al. A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child.\u20082004;89(7):653\u2013659","DOI":"10.1136\/adc.2003.027722"},{"key":"2021120902464201000_R37","doi-asserted-by":"crossref","unstructured":"Dunning J, Daly JP, Lomas J-P, et al. 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