• Joseph A Grubenhoff, Dustin Currie, R Dawn Comstock, Elizabeth Juarez-Colunga, Lalit Bajaj, and Michael W Kirkwood.
• Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO. Electronic address: Joe.grubenhoff@childrenscolorado.org.
• J. Pediatr. 2016 Jul 1; 174: 27-32.e1.

ObjectiveTo characterize the psychological factors associated with persistent symptoms after pediatric concussion.Study DesignLongitudinal cohort study of 179 children with concussion 8-18 years old evaluated in a pediatric emergency department. Participants were followed for 1 month for delayed symptom resolution, defined as ≥3 symptoms that were new/worse than preinjury symptoms measured by the use of graded symptom inventory. Preinjury psychological traits were measured by parental report on subscales of the Personality Inventory for Children-2 (maladjustment, cognitive abilities, somatization). Child report of postinjury anxiety and injury perception were measured with the State-Trait Anxiety Inventory for Children and Children's Illness Perception Questionnaire. Psychological instrument scores were compared between those with and without delayed symptom resolution via a Kruskal-Wallis test. Associations between psychological traits and delayed symptom resolution were investigated by the use of logistic regression.ResultsDelayed symptom resolution occurred in 21% of participants. Score distributions were significantly worse on the State-Trait Anxiety Inventory for Children (38 [IQR 33-40] vs 35 [IQR 31-39]; P = .04) and somatization subscale (1 [IQR 0-3] vs 1 [IQR 0-1]; P = .01) among children with delayed symptom resolution compared with children with early symptom resolution. Somatization was associated with delayed symptom resolution (aOR 1.35, 95% CI 1.08-1.69). The proportion of children with abnormal somatization scores was significantly greater in the delayed symptom resolution group (34.2%) than the early symptom resolution group (12.8%; P < .01). Other psychological measures were not different between groups.ConclusionSomatization is associated with delayed symptom resolution in this cohort of children with concussion. Postconcussive symptoms lasting at least 1 month may warrant referral to a neuropsychologist familiar with postconcussion care.Copyright © 2016 Elsevier Inc. All rights reserved.

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