Optimal Recovery Following Pediatric Concussion
Bibliographic record
Abstract
Importance: Pediatric concussion affects millions and results in heterogeneous outcomes and recovery trajectories. Given favorable outcome for most children, it is useful to understand characteristics of positive outcome to promote full recovery in all children. Objective: To document the timeframe of recovery to optimal functioning, defined comprehensively across motor-physical, cognitive, socioemotional, and resilience-support domains, after concussion among children ages 8 to 16 years. Design, Setting, and Participants: For this prospective cohort study, children ages 8 to 16.99 years with a concussion or orthopedic injury (OI) were recruited between September 2016 and July 2019 from 5 Pediatric Emergency Research Canada emergency departments and assessed approximately 10 days, 3 months, and 6 months after their injury. Data were analyzed from January 29, 2024, to January 11, 2025. Exposure: Concussion. Main Outcomes and Measures: Participants completed self-report and direct assessment measures of postconcussive symptoms, physical activity and function, balance, cognitive function, quality of life, resilience, and social support. The main outcome was optimal functioning, which was derived from 11 variables and criteria indicative of absence of impairment and average or above functioning in each domain (overall score, 0-11; higher score indicates better function). A longitudinal, multivariable, cumulative probability ordinal regression model was fitted to examine factors associated with optimal functioning. Results: A total of 967 children (median [IQR] age, 12.3 [10.5-14.3] years; 562 [58.1%] male) were enrolled, including 633 children with a concussion and 334 children with an OI. The median (IQR) optimal functioning scores for the OI group were 6.0 (4.0-8.0) at 10 days, 7.0 (5.0-9.0) at 3 months, and 7 (5.0-9.0) at 6 months, compared with 4.0 (2.0-6.0) at 10 days, 6.0 (4.0-9.0) at 3 months, and 7.0 (4.0-9.0) at 6 months in the concussion group. The 3 main variables (time, sex, and group) were significantly associated with optimal functioning, as were all 2-way interactions. Time was the strongest factor associated with optimal functioning (Wald χ258 = 485.11; P < .001), followed by group (Wald χ26 = 95.10; P < .001), and sex (Wald χ26 = 23.19; P < .001). At the 10-day follow-up, concussion was associated with lower optimal functioning than OI among females (odds ratio [OR], 0.24 [95% CI, 0.16-0.36]) and males (OR, 0.37 [95% CI, 0.26-0.53]). This difference persisted for females at 3 months (OR, 0.57 [95% CI, 0.35-0.93]) but not for males. Optimal functioning was comparable at 6 months. Conclusions and Relevance: In this prospective cohort study of children with concussion, achieving optimal functioning levels across physical, cognitive, socioemotional, and resilience domains took 3 months or more, especially for girls with concussion. Multiple domains of outcome need to be taken into account when considering full recovery and optimal function after pediatric concussion.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".