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Postconcussive Symptoms Following Mild TBI and Extracranial Injury: What Are the Contributing Factors?

Published online by Cambridge University Press:  11 December 2019

Coco O. Bernard Open the ORCID record for Coco O. Bernard [Opens in a new window] ,
Audrey McKinlay ,
David Krieser  and
Jennie L. Ponsford
Coco O. Bernard*
Affiliation:
School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
Audrey McKinlay
Affiliation:
Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia
David Krieser
Affiliation:
Sunshine Hospital Emergency Department, Melbourne, Victoria 3021, Australia
Jennie L. Ponsford
Affiliation:
School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
*
*Correspondence and reprint requests to: Dr Coco O. Bernard, School of Psychological Sciences, Monash University, Victoria, Australia. E-mail: [email protected]
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Abstract

Objectives:

Whether mild traumatic brain injury (mTBI) sustained by children results in persistent or recurrent symptoms, over and above those experienced by children who solely sustain mild extracranial injuries, remains debated. The current prospective longitudinal case-controlled study aimed to examine the relative influence of injury and noninjury factors on symptoms in preschool and primary school-aged children who sustained an mTBI or mild extracranial injury at least 8 month earlier.

Methods:

Participants were 64 parents of children (31 mTBI, 33 trauma controls) who sustained injury between ages 2 and 12, whose postconcussive symptoms across the first 3-month postinjury have been previously described. The current study assessed postconcussive symptoms at 8 or more months postinjury (M = 24.3, SD = 8.4) and examined a range of injury and noninjury predictive factors.

Results:

At or beyond 8-month postinjury, symptom numbers in the mTBI group were comparable with those of the group who sustained mild extracranial injury. Educational attainment of parents (below or above high-school attainment level) was the only predictor of symptoms at follow-up, with preexisting learning difficulties approaching significance as a predictor.

Conclusions:

While our earlier study found that mTBI was associated with symptoms at 3-month postinjury, follow-up at more than 8 months showed mTBI no longer predicted symptom reporting. While mTBI contributes significantly to the presence of symptoms in the first few months postinjury, researchers and healthcare practitioners in this field need to consider the potential impact of noninjury factors on persistent or recurrent symptoms after mTBI.

Keywords

Mild traumatic brain injuryPostconcussive symptomsChildrenOutcomesConcussionPaediatric
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 26 , Issue 5 , May 2020 , pp. 451 - 463
Copyright
Copyright © INS. Published by Cambridge University Press, 2019

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References

REFERENCES

Abidin, R. (1983). Parental Stress Index (3rd ed.). Lutz, Florida: Psychological Assessment Resources, Inc.Google Scholar
Anderson, V., Catroppa, C., Morse, S., Haritou, F., & Rosenfeld, J. (2009). Intellectual outcome from preschool traumatic brain injury: a 5-year prospective, longitudinal study. Pediatrics, 124(6), e1064–e1071. doi: 10.1542/peds.2009-0365CrossRefGoogle ScholarPubMed
Anderson, V., Godfrey, C., Rosenfeld, J.V., & Catroppa, C. (2012). Predictors of cognitive function and recovery 10 years after traumatic brain injury in young children. Pediatrics, 129(2), e254–e261. doi: 10.1542/peds.2011-0311CrossRefGoogle ScholarPubMed
Anderson, V., & Moore, C. (1995). Age at injury as a predictor of outcome following pediatric head injury: a longitudinal perspective. Child Neuropsychology, 1(3), 187–202. doi: 10.1080/09297049508400224CrossRefGoogle Scholar
Anderson, V., Morse, S., Catroppa, C., Haritou, F., & Rosenfeld, J. (2004). Thirty month outcome from early childhood head injury: a prospective analysis of neurobehavioural recovery. Brain, 127, 2608.10.1093/brain/awh320CrossRefGoogle ScholarPubMed
Anderson, V. & Yeates, K. (1997). Pediatric head injury: developmental Implications Introduction from the symposium organizers. Journal of the International Neuropsychological Society, 3(6), 553–554.10.1017/S1355617797005535CrossRefGoogle Scholar
Babikian, T., McArthur, D., & Asarnow, R. (2013). Predictors of 1-month and 1-year neurocognitive functioning from the UCLA longitudinal mild, uncomplicated, pediatric traumatic brain injury study. Journal of the International Neuropsychological Society, 19(2), 145–154. doi: 10.1017/S135561771200104XCrossRefGoogle ScholarPubMed
Barlow, K.M. (2016). Postconcussion syndrome: a review. Journal of Child Neurology, 31(1), 57–67.10.1177/0883073814543305CrossRefGoogle ScholarPubMed
Barlow, K.M., Crawford, S., Stevenson, A., Sandhu, S.S., Belanger, F., & Dewey, D. (2010). Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury. Pediatrics, 126(2), 374–381. doi: 10.1542/peds.2009-0925CrossRefGoogle ScholarPubMed
Bernard, C., McKinlay, A., Krieser, D., Testa, R., & Ponsford, J. (2017). Acute post-concussive symptoms in young children. Brain Injury, 31(11), 1414–1421. doi: 10.1080/02699052.2017.1350999CrossRefGoogle ScholarPubMed
Bernard, C., Ponsford, J., McKinlay, A., McKenzie, D., & Krieser, D. (2016). Predictors of post-concussive symptoms in young children: injury versus non-injury related factors. Journal of the International Neuropsychological Society, 22(8), 793–803. doi: 10.1017/S1355617716000709CrossRefGoogle Scholar
Bernard, C., Ponsford, J., McKinlay, A., McKenzie, D., & Krieser, D. (2017). Do concussive symptoms really resolve in young children? Journal of Head Trauma Rehabilitation, 32(6), 1–12. doi: 10.1097/HTR.0000000000000298CrossRefGoogle ScholarPubMed
Biederman, J., Feinberg, L., Chan, J., Adeyemo, B.O., Woodworth, K., Panis, W., McGrath, N., Bhatnagar, S., Spencer, T.J., Uchida, M., Kenworthy, T., Grossman, R., Zafonte, R., & Faraone, S.V. (2015). Mild traumatic brain injury and attention-deficit hyperactivity disorder in young student athletes. Journal of Nervous and Mental Disease, 203(11), 813–819. doi: 10.1097/NMD.0000000000000375CrossRefGoogle ScholarPubMed
Bracken, B. & Keith, L. (2004). Clinical Assessment of Behaviour. Lutz, FL: Psychological Assessment Resources, Inc.Google Scholar
Carroll, L., Cassidy, J., Holm, L., Kraus, J., & Coronado, V. (2004). Methodological issues and research recommendations for mild traumatic brain injury: the WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 43, 113–125. doi: 10.1080/16501960410023877CrossRefGoogle Scholar
Carroll, L., Cassidy, J., Peloso, P., Borg, J., von Holst, H., Holm, L., Paniak, C., & Pepin, M. (2004). Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 36(43), 84–105.10.1080/16501960410023859CrossRefGoogle Scholar
Cronbach, L. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334.10.1007/BF02310555CrossRefGoogle Scholar
Crowe, L., Babl, F., Anderson, V., & Catroppa, C. (2009). The epidemiology of paediatric head injuries: data from a referral centre in Victoria, Australia. Journal of Paediatrics and Child Health, 45(6), 346–350.10.1111/j.1440-1754.2009.01499.xCrossRefGoogle ScholarPubMed
Crowe, L., Catroppa, C., Babl, F.E., Rosenfeld, J., & Anderson, V. (2012). Timing of traumatic brain injury in childhood and intellectual outcomes. Journal of Pediatric Psychology, 37(7), 745–754. doi: 10.1093/jpepsy/jss070CrossRefGoogle Scholar
Dunn, J., Lees-Haley, P., Brown, R., Williams, C., & English, L. (1995). Neurotoxic complaint base rates of personal injury claimants: implications for neuropsychological assessment. Journal of Clinical Psychology, 51, 577–584. doi: 0.1002/1097-4679(199507)51:4<577:AID-JCLP2270510418>3.0.CO;2-E3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Fay, T.B., Yeates, K.O., Taylor, H., Bangert, B., Dietrich, A., Nuss, K., Rusin, J., & Wright, M. (2010). Cognitive reserve as a moderator of postconcussive symptoms in children with complicated and uncomplicated mild traumatic brain injury. Journal of the International Neuropsychological Society, 16(1), 94–105. doi: 10.1017/S1355617709991007CrossRefGoogle ScholarPubMed
Fox, D.D., Lees-haley, P.R., Earnest, K., & Dolezal-wood, S. (1995). Post-Concussive symptoms: Base rates and etiology in psychiatric patients. The Clinical Neuropsychologist, 9(1), 89–92. doi: 10.1080/13854049508402064CrossRefGoogle Scholar
Gagnon, I., Swaine, B.R., Friedman, D., & Forget, R. (2005). Exploring children’s self-efficacy related to physical activity performance after a mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 20, 436–449.CrossRefGoogle ScholarPubMed
Ganesalingam, K., Yeates, K.O., Ginn, M.S., Taylor, H., Dietrich, A., Nuss, K., & Wright, M. (2008). Family burden and parental distress following mild traumatic brain injury in children and its relationship to post-concussive symptoms. Journal of Pediatric Psychology, 33(6), 621–629. doi: 10.1093/jpepsy/jsm133CrossRefGoogle ScholarPubMed
Gasquoine, P. (2000). Postconcussional symptoms in chronic back pain. Applied Neuropsychology, 7, 83–89.CrossRefGoogle ScholarPubMed
Gibbons, R.D., Hedeker, D., Elkin, I., Waternaux, C., Kraemer, H.C., Greenhouse, J.B., Shea, M.T., Imber, S.D., Sotsky, S.M., & Watkins, J.T. (1993). Some conceptual and statistical issues in analysis of longitudinal psychiatric data: application to the NIMH treatment of depression collaborative research program dataset. Archives of General Psychiatry, 50(9), 739–750. doi: 10.1001/archpsyc.1993.01820210073009CrossRefGoogle ScholarPubMed
Gioia, G. (2016). Medical-school partnership in guiding return to school following mild traumatic brain injury in youth. Journal of Child Neurology, 31(1), 93–108. doi: 10.1177/0883073814555604CrossRefGoogle ScholarPubMed
Gioia, G., Collins, M., & Isquith, P.K. (2008). Improving identification and diagnosis of mild traumatic brain injury with evidence: psychometric support for the acute concussion evaluation. The Journal of Head Trauma Rehabilitation, 23(4), 230–242. doi: 10.1097/01.HTR.0000327255.38881.caCrossRefGoogle ScholarPubMed
Gioia, G., Schneider, J., Vaughan, C., & Isquith, P. (2009). Which symptom assessments and approaches are uniquely appropriate for paediatric concussion? British Journal of Sports Medicine, 43(Suppl. 1), i13–i22. doi: 10.1136/bjsm.2009.058255CrossRefGoogle ScholarPubMed
Giza, C.C. & Hovda, D.A. (2014). The new neurometabolic cascade of concussion. Neurosurgery, Suppl 4, S24–S33. doi: 10.1227/NEU.0000000000000505CrossRefGoogle Scholar
Goodlin-Jones, B., Sitnick, S., Tang, K., Liu, J., & Anders, T. (2008). The children’s sleep habits questionnaire in toddlers and preschool children. Journal of Developmental and Behavioral Pediatrics, 29(2), 82–88. doi: 10.1097/DBP.0b013e318163c39aCrossRefGoogle ScholarPubMed
Hajek, C.A., Yeates, K.O., Taylor, H., Bangert, B., Dietrich, A., Nuss, K.E., Rusin, J., & Wright, M. (2011). Agreement between parents and children on ratings of post-concussive symptoms following mild traumatic brain injury. Child Neuropsychology, 17(1), 17–33. doi: 10.1080/09297049.2010.495058CrossRefGoogle ScholarPubMed
Hawley, C. (2003). Reported problems and their resolution following mild, moderate and severe traumatic brain injury amongst children and adolescents in the UK. Brain Injury, 17, 105.10.1080/0269905021000010131CrossRefGoogle ScholarPubMed
Hooper, S.R., Alexander, J., Moore, D., Sasser, H.C., Laurent, S., King, J., Bartel, S., & Callahan, B. (2004). Caregiver reports of common symptoms in children following a traumatic brain injury. NeuroRehabilitation, 19(3), 175–189.CrossRefGoogle ScholarPubMed
Hosmer, D. , Lemeshow, S. , & Sturdivant, R. (2013). Applied Logistic Regression (3rd ed.). Hoboken, New Jersey: Wiley.10.1002/9781118548387CrossRefGoogle Scholar
Iverson, G. (2006). Complicated vs uncomplicated mild traumatic brain injury: acute neuropsychological outcome. Brain Injury, 20(13–14), 1335–1344. doi: 10.1080/02699050601082156CrossRefGoogle ScholarPubMed
Iverson, G. & Lange, R. (2003). Examination of “postconcussion-Like” symptoms in a healthy sample. Applied Neuropsychology, 10(3), 137–144. doi: 10.1207/S15324826AN1003_02CrossRefGoogle Scholar
Jennett, B. (1976). Assessment of the severity of head injury. Journal of Neurology, Neurosurgery & Psychiatry, 39(7), 647–655. doi: 10.1136/jnnp.39.7.647CrossRefGoogle ScholarPubMed
Kirkwood, M.W., Peterson, R.L., Baker, D.A., & Connery, A.K. (2017). Parent satisfaction with neuropsychological consultation after pediatric mild traumatic brain injury. Child Neuropsychology, 23(3), 273–283. doi: 10.1080/09297049.2015.1130219CrossRefGoogle ScholarPubMed
Kirkwood, M.W., Yeates, K., Taylor, H., Randolph, C., McCrea, M., & Anderson, V. (2008). Management of pediatric mild traumatic brain injury: a neuropsychological review from injury through recovery. The Clinical Neuropsychologist, 22(5), 769–800. doi: 10.1080/13854040701543700CrossRefGoogle ScholarPubMed
Koepsell, T.D., Rivara, F.P., Vavilala, M.S., Wang, J., Temkin, N., Jaffe, K.M., & Durbin, D.R. (2011). Incidence and descriptive epidemiologic features of traumatic brain injury in King County, Washington. Pediatrics, 128(5), 946–954. doi: 10.1542/peds.2010-2259CrossRefGoogle ScholarPubMed
Kolb, B. (1999). Synaptic plasticity and the organization of behaviour after early and late brain injury. Canadian Journal of Experimental Psychology, 53(1), 62–76. doi: 10.1037/h0087300CrossRefGoogle ScholarPubMed
Kraus, J., Schaffer, K., Ayers, K., Stenehjem, J., Shen, H., & Afifi, A.A. (2005). Physical complaints, medical service use, and social and employment changes following mild traumatic brain injury: a 6–month longitudinal study. The Journal of Head Trauma Rehabilitation, 20(3), 239–256.CrossRefGoogle ScholarPubMed
Lees-Haley, P.R. & Brown, R.S. (1993). Neuropsychological complaint base rates of 170 personal injury claimants. Archives of Clinical Neuropsychology, 8(3), 203–209.10.1093/arclin/8.3.203CrossRefGoogle ScholarPubMed
Max, J., Schachar, R., Levin, H., Ewing-Cobbs, L., Chapman, S.B., Dennis, M., Saunders, A., & Landis, J. (2005). Predictors of secondary attention-deficit/hyperactivity disorder in children and adolescents 6 to 24 months after traumatic brain injury. Journal of the American Academy of Child and Adolescent Psychiatry, 44(10), 1041–1049. doi: 10.1097/01.chi.0000173292.05817.f8CrossRefGoogle ScholarPubMed
McKinlay, A. (2009). Controversies and outcomes associated with mild traumatic brain injury in childhood and adolescences. Child Care, Health & Development, 36(1), 3–21. doi: 10.1111/j.1365-2214.2009.01006.xCrossRefGoogle ScholarPubMed
McKinlay, A., Dalrymple-Alford, J., Norwood, L., & Fergusson, D. (2002). Long term psychosocial outcomes after mild head injury in early childhood. Journal of Neurology, Neurosurgery & Psychiatry, 73(3), 281–288. doi: 10.1136/jnnp.73.3.281CrossRefGoogle ScholarPubMed
McKinlay, A., Grace, R., Horwood, L., Fergusson, D., Ridder, E., & MacFarlane, M. (2008). Prevalence of traumatic brain injury among children, adolescents and young adults: prospective evidence from a birth cohort. Brain Injury, 22(2), 175–181. doi: 10.1080/02699050801888824CrossRefGoogle Scholar
McKinlay, A., Ligteringen, V., & Than, M. (2014). A comparison of concussive symptoms reported by parents for preschool versus school-aged children. The Journal of Head Trauma Rehabilitation, 29(3), 233–238. doi: 10.1097/HTR.0b013e3182a2dd7fCrossRefGoogle ScholarPubMed
McNally, K.A., Bangert, B., Dietrich, A., Nuss, K., Rusin, J., Wright, M., Taylor, H.G., & Yeates, K.O. (2013). Injury versus noninjury factors as predictors of postconcussive symptoms following mild traumatic brain injury in children. Neuropsychology, 27(1), 1–12. doi: 10.1037/a0031370CrossRefGoogle ScholarPubMed
Meisenberg, G. & Williams, A. (2008). Are acquiescent and extreme response styles related to low intelligence and education? Personality and Individual Differences, 44(7), 1539–1550.10.1016/j.paid.2008.01.010CrossRefGoogle Scholar
Melo, J.R.T., Lemos-Junior, L.P., Reis, R.C., Araujo, A.O., Menezes, C.W., Santos, G.P., Barreto, B.B., Menezes, T., & Oliveira-Filho, J. (2010). Do children with Glasgow 13/14 could be identified as mild traumatic brain injury? Arquivos de Neuro-Psiquiatria, 68(3), 381–384. doi: 10.1590/S0004-282X2010000300010CrossRefGoogle ScholarPubMed
Mittenberg, W., Wittner, M.S., & Miller, L.J. (1997). Postconcussion syndrome occurs in children. Neuropsychology, 11(3), 447–452.10.1037/0894-4105.11.3.447CrossRefGoogle ScholarPubMed
Olsson, K.A., Lloyd, O.T., LeBrocque, R.M., McKinlay, L., Anderson, V.A., & Kenardy, J.A. (2013). Predictors of child post-concussion symptoms at 6 and 18 months following mild traumatic brain injury. Brain Injury, 27(2), 145–157. doi: 10.3109/02699052.2012.729286CrossRefGoogle ScholarPubMed
Owens, J.A., Spirito, A., & McGuinn, M. (2000). The Children’s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep: Journal of Sleep and Sleep Disorders Research, 23(8), 1–9.CrossRefGoogle ScholarPubMed
Ponsford, J., Olver, J., Nelms, R., Curran, C., & Ponsford, M. (1999). Outcome measurement in an inpatient and outpatient traumatic brain injury rehabilitation programme. Neuropsychological Rehabilitation, 9(3–4), 517–534. doi: 10.1080/096020199389563CrossRefGoogle Scholar
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Ayton, G., Nelms, R., Curran, C., & Ng, K. (2001). Impact of early intervention on outcome after mild traumatic brain injury in children. Pediatrics, 108(6), 1297–1303.CrossRefGoogle ScholarPubMed
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Ayton, G., Nelms, R., Curran, C., & Ng, K.T. (1999). Cognitive and behavioral outcome following mild traumatic head injury in children. The Journal of Head Trauma Rehabilitation, 14(4), 360–372. doi: 10.1097/00001199-199908000-00005CrossRefGoogle ScholarPubMed
Risen, S.R., Reesman, J., Yenokyan, G., Slomine, B.S., & Suskauer, S.J. (2017). The course of concussion recovery in children 6–12 years of age: experience from an interdisciplinary rehabilitation clinic. PM R, 9(9), 874–883. doi: 10.1016/j.pmrj.2016.12.005CrossRefGoogle ScholarPubMed
Russo, R.N., Rice, J., Chern, P.M., & Raftos, J. (2012). Minimal and mild paediatric brain injury: A 3-year cohort of consecutive presentations. Developmental Neurorehabilitation, 15(1), 13–18. doi: 10.3109/17518423.2011.625558CrossRefGoogle ScholarPubMed
Satz, P. (1993). Brain reserve capacity on symptom onset after brain injury: a formulation and review of evidence for threshold theory. Neuropsychology, 7(3), 273–295. doi: 10.1037/0894-4105.7.3.273CrossRefGoogle Scholar
Satz, P., Zaucha, K., McCleary, C., Light, R., Asarnow, R., & Becker, D. (1997). Mild head injury in children and adolescents: a review of studies (1970–1995). Psychological Bulletin, 122, 107–131.10.1037/0033-2909.122.2.107CrossRefGoogle Scholar
StataCorp. (2013). Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.Google Scholar
Suskauer, S.J., Rane, S., Reesman, J., & Slomine, B.S. (2018). Caregiver-report of symptoms following traumatic brain injury in a small clinical sample of preschool-aged children. Journal of Pediatric Rehabilitation Medicine, 11(1), 7–14. doi: 10.3233/prm-160424CrossRefGoogle Scholar
Taylor, H. & Alden, J. (1997). Age-related differences in outcomes following childhood brain insults: an introduction and overview. Journal of the International Neuropsychological Society, 3(6), 555–567. doi: 10.1017/S1355617797005559CrossRefGoogle ScholarPubMed
Thomas, D.G. (2012). Acute Treatment of Concussion. In Apps, J.N. & Walter, K.D. (Eds.), Paediatrics and Adolescent Concussion: Diagnosis, Management and Outcomes (pp. 73–80). New York: Springer Science+Business Media.CrossRefGoogle Scholar
Wade, S., Cassedy, A., Walz, N., Taylor, H., Stancin, T., & Yeates, K. (2011). The relationship of parental warm responsiveness and negativity to emerging behavior problems following traumatic brain injury in young children. Developmental Psychology, 47(1), 119–133. doi: 10.1037/a0021028CrossRefGoogle ScholarPubMed
Yeates, K. (2010). Mild traumatic brain injury and postconcussive symptoms in children and adolescents. Journal of the International Neuropsychological Society, 16(6), 953–960. doi: 10.1017/S1355617710000986CrossRefGoogle ScholarPubMed
Yeates, K. & Taylor, H. (2005). Neurobehavioural outcomes of mild head injury in children and adolescents Pediatric Rehabilitation, 8(1), 5–16. doi: 10.1080/13638490400011199Google ScholarPubMed
Yeates, K., Taylor, H., Barry, C., Drotar, D., Wade, S., & Stancin, T. (2001). Neurobehavioral symptoms in childhood closed-head injuries: changes in prevalence and correlates during the first year postinjury. Journal of Pediatric Psychology, 26(2), 79–91. doi: 10.1093/jpepsy/26.2.79CrossRefGoogle ScholarPubMed
Yeates, K., Taylor, H., Rusin, J., Bangert, B., Dietrich, A., Nuss, K., & Wright, M. (2012). Premorbid child and family functioning as predictors of post-concussive symptoms in children with mild traumatic brain injuries. International Journal of Developmental Neuroscience, 30(3), 231–237. doi: 10.1016/j.ijdevneu.2011.05.008CrossRefGoogle ScholarPubMed
Yeates, K., Taylor, H., Rusin, J., Bangert, B., Dietrich, A., Nuss, K., Wright, M., Nagin, D.S., & Jones, B. (2009). Longitudinal trajectories of postconcussive symptoms in children with mild traumatic brain injuries and their relationship to acute clinical status. Pediatrics, 123, 735–743. doi: 10.1542/peds.2008-1056CrossRefGoogle ScholarPubMed
Yeates, K., Taylor, H., Walz, N., Stancin, T., & Wade, S. (2010). The family environment as a moderator of psychosocial outcomes following traumatic brain injury in young children. Neuropsychology, 24(3), 345–356. doi: 10.1037/a0018387CrossRefGoogle ScholarPubMed
Zemek, R., Barrowman, N., Freedman, S.B., Gravel, J., Gagnon, I., McGahern, C., Aglipay, M., Sangha, G., Boutis, K., Beer, D., Craig, W., Burns, E., Farion, K.J., Mikrogianakis, A., Barlow, K., Dubrovsky, A.S., Meeuwisse, W., Gioia, G., Meehan, W.P., Beauchamp, M.H., Kamil, Y., Grool, A.M., Hoshizaki, B., Anderson, P., Brooks, B.L., Yeates, K.O., Vassilyadi, M., Klassen, T., Keightley, M., Richer, L., DeMatteo, C., & Osmond, M.H. (2016). clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. Journal of the American Medical Association, 315(10), 1014–1025. doi: 10.1001/jama.2016.1203CrossRefGoogle ScholarPubMed
Zemek, R., Farion, K.J., Sampson, M., & McGahern, C. (2013). Prognosticators of persistent symptoms following pediatric concussion: a systematic review. JAMA Pediatrics, 167(3), 259–265. doi: 10.1001/2013.jamapediatrics.216CrossRefGoogle ScholarPubMed