To determine whether patients with complicated mTBI experience a higher symptom burden compared to those with uncomplicated mTBI.

In 2022, 837,000 children and adolescents in the United States were diagnosed with traumatic brain injury (TBI). Of these cases, 75% were classified as mild TBI (mTBI), which, while “mild” by definition, encompasses a heterogenous spectrum of presentation, ranging from patients with no intracranial abnormalities (uncomplicated mTBI), to those with acute traumatic intracranial findings (complicated mTBI). The relationship between complicated mTBI and post-injury symptom burden remains understudied.

In this retrospective cohort study, we analyzed data from 405 pediatric patients aged 5 – 21 diagnosed with mTBI who were evaluated at a concussion clinic between April 2021-February 2025. Patients were included if they completed a Post-Concussion Symptom Scale (PCSS). We analyzed demographic, injury, and symptom data. We assessed differences in symptom burden between those with complicated mTBI and those with uncomplicated mTBI with Fisher’s tests and regression-based methods, adjusting for covariates.

Of 340 eligible patients, 68 (20%) had complicated mTBI. These patients presented to clinic significantly faster than uncomplicated mTBI patients (median 29 vs 81 days; p < 0.001). They reported fewer symptoms across multiple domains, including trouble falling asleep (p = 0.002), anxiety (p = 0.019), brain fog (p = 0.001), and poor concentration (p = 0.008). Their overall symptom burden was lower (median score 7 vs 20; p < 0.001), and after adjusting for covariates, they exhibited a 44% lower expected symptom score (ratio 0.56; p = 0.009) compared with uncomplicated mTBI.

Pediatric patients with complicated mTBI reported fewer post-concussive symptoms than those with uncomplicated mTBI. This difference may be mediated by earlier follow-up and counseling in Concussion Clinic. Our findings underscore the need for timely post-concussion care and suggest that evidence of intracranial hemorrhage may not predict greater symptom burden.