# A Risk Stratification Model for Health and Academic Outcomes in Children with Concussion Based on Novel Symptom Trajectory Typologies

> **NIH NIH R01** · DUKE UNIVERSITY · 2024 · $586,504

## Abstract

ABSTRACT.
Concussions occur at an alarming rate among U.S. schoolchildren, with one in five children experiencing a
concussion by age 16. The number of children visiting emergency departments for concussions annually has
increased by 50% over the past decade, with an estimated cost to the healthcare system of $1 billion/year.
Compared to adults, children experience longer and more severe postconcussive symptoms (PCS). Severity
and duration of PCS, however, vary considerably among children, complicating clinical care and return to learn
and play. Persistent PCS including physical, emotional, and cognitive symptoms, result in increased school
absenteeism, social isolation, and psychological distress. Early PCS diagnosis and access to evidence-based
return-to-health and -school interventions are strongly linked to positive health and academic outcomes. Yet
models to identify children at high risk for persistent PCS are lacking. PCS have been linked to inflammatory
processes occurring within the injured brain. Preliminary evidence suggests that fatigue, another symptom
likely contributing to poor outcomes, is also a biological byproduct of pediatric concussions. Importantly, even
though 73% of children report continuous fatigue after concussion, this symptom is rarely studied along with
other PCS. Prior research has focused on the relationship between inflammatory biomarkers and PCS severity
but has not examined this relationship longitudinally. Acute symptom severity alone, however, is a poor
prognostic of clinical outcomes in concussed children. Symptom severity immediately postinjury does not
explain why at least 25% of children still experience PCS after 1 year or why even children who may appear
asymptomatic still report academic and social challenges months after concussion. To identify which children
are at high risk for persistent PCS and poor health, academic, and social outcomes, research tracking PCS
trajectories and describing school-based impacts across the entire first year postinjury is critically needed. This
proposal will 1) define novel PCS trajectory typologies in a racially/ethnically diverse population of 500 children
with concussion (11–17 years, near equal distribution by sex), 2) identify associations between these
typologies and patterns of inflammatory biomarkers, 3) develop a risk stratification model to identify children at
risk for persistent PCS; and 4) gain unique insights and describe PCS impact, including fatigue, on longer-term
academic and social outcomes. We will be the first to use NIH's symptom science model and patient-reported
outcomes to explore the patterns of fatigue and other physical, cognitive, psychological, emotional and
academic responses to concussion in children over a full year. Our model will enable clinicians and educators
to identify children most at risk for poor long-term health, social, and academic outcomes after concussion.
This work is critical to meeting our long-term goal of developing pe...

## Key facts

- **NIH application ID:** 10795957
- **Project number:** 5R01NS129617-02
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** KARIN REUTER-RICE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $586,504
- **Award type:** 5
- **Project period:** 2023-03-01 → 2028-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10795957

## Citation

> US National Institutes of Health, RePORTER application 10795957, A Risk Stratification Model for Health and Academic Outcomes in Children with Concussion Based on Novel Symptom Trajectory Typologies (5R01NS129617-02). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10795957. Licensed CC0.

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