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Early versus delayed emergency department presentation following mild Traumatic Brain Injury and the presence of symptom at 1, 4 and 12 weeks in children
  1. Jocelyn Gravel1,2,
  2. Andrée-Ann Ledoux3,
  3. Ken Tang3,
  4. Keith Owens Yeates4,
  5. William Craig5,
  6. Martin Osmond6,
  7. Kathy Boutis7,8,
  8. Emma Burns9,
  9. Gurinder Sangha8,
  10. Alexander Sasha Dubrovsky10,
  11. Darcy Beer11,
  12. Roger Zemek6
  1. 1 Department of Pediatrics, CHU Sainte-Justine, Montreal, Québec, Canada
  2. 2 Paediatrics, Universite de Montreal, Montreal, Québec, Canada
  3. 3 CHEO Research Institute, Ottawa, Ontario, Canada
  4. 4 Psychology, University of Calgary, Calgary, Alberta, Canada
  5. 5 Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
  6. 6 Pediatrics, CHEO, Ottawa, Ontario, Canada
  7. 7 Pediatrics, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
  8. 8 Paediatrics, Children's Hospital, London, Ontario, Canada
  9. 9 Emergency, Dalhousie University, Halifax, Nova Scotia, Canada
  10. 10 Pediatric Emergency, Montreal Children's Hospital, Montreal, Québec, Canada
  11. 11 Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Jocelyn Gravel, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; graveljocelyn{at}


Objectives We evaluated the association between timing of presentation and postconcussive symptoms (PCS) at 1, 4 and 12 weeks after injury.

Methods This was a secondary analysis of a prospective cohort study conducted in nine Canadian paediatric EDs in 2013–2015 (5P study). Participants were children who suffered a head injury within the preceding 48 hours and met Zurich consensus concussion diagnostic criteria. The exposure was the time between head injury and ED presentation. The primary outcome was the presence of PCS at 1 week defined by the presence of at least three symptoms on the Post-Concussion Symptom Inventory (PCSI). Secondary outcomes evaluated PCS at 4 and 12 weeks. Multivariable logistic regression analyses were adjusted for ED PCSI and other potential confounders.

Results There were 3041 patients with a concussion in which timing of the injury was known. 2287 (75%) participants sought care in the first 12 hours, 388 (13%) 12–24 hours after trauma and 366 (12%) between 24 and 48 hours. Compared with children who sought care >24 hours after trauma, children who sought care in the first 12 hours had a significantly lower incidence of PCS at 1 week (OR: 0.55 (95% CI 0.41 to 0.75)) and 4 weeks (OR: 0.74 (95% CI 0.56 to 0.99)) but not at 12 weeks (OR: 0.88 (95% CI 0.63 to 1.23)).

Conclusions Patients who present early after a concussion appear to have a shorter duration of PCS than those presenting more than 12 hours later. Patients/families should be informed of the higher probability of PCS in children with delayed presentation.

  • trauma, head
  • paediatric injury
  • paediatric emergency med

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  • Contributors JG designed the study, supervised the data analysis, drafted the manuscript and finalised the submission. AAL, KOY, MO, WC, KB, EB, GS, ASD, DB and RZ participated in the study design, revised the manuscript and provided approval for the final version. KT participated in the study design, conducted the initial statistical analysis and provided feedback on the manuscript. RZ was the instigator of the primary study (5P study). All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This work was supported by the Canadian Institute of Research Health (grant number 293380).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The initial study and subsequent studies were approved by the Research Ethics Board of the nine participating institutions.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data from this study are not publicly available. It may be available for researchers upon request.