Objective To characterize symptom burden, school functioning, and physical-activity outcomes in youth 1-year following acute concussion and those with subsequent repeat concussion.

Design Secondary analysis of 5P prospective, multicenter cohort study.

Setting Nine Canadian pediatric emergency departments (ED).

Participants Youth presenting ≤48-hours of concussion and agreed to participate in a post-hoc electronic survey at 1-year following injury.

Assessment of Risk Factors Standardized 25-question symptom scale derived from the Post-Concussion Symptom Inventory-Parent; school and physical-activity outcomes.

Outcome Measures Primary outcome was total symptom score at 1-year following concussion, defined as the number of symptoms experienced more than before injury.

Main Results Of 3063 youth enrolled in the 5P study, 441 (median [IQR] age, 11.45 [8.86–14.04] years; 272 [61.7%] male) completed the 1-year survey; 37 respondents reported repeat concussion. Following acute concussion, youth were more likely to be symptom-free than following repeat concussion (74%vs.54%; difference=20%[95%CI:6,37]; p=.005) and to have fully recovered (91%vs.76%; difference=15%[95%CI:4, 3]; p=.005) at 1-year. Although physical symptoms were lower at 1-year than ED presentation for both groups (p<.001), more youth with repeat concussion reported headache persistence (24%vs.12%; difference=12%[95%CI:0,28]; p=.04). Both groups returned to normal school routines (100%vs.95%; difference=5%[95%CI:-5,8; p=.59). Youth without repeat concussion more frequently returned to normal physical activities (98%vs.87%; difference=12%[95%CI:4,26]; p<.001) and sport (95%vs.84%; difference=11%[95%CI:23,27]; p=.02).

Conclusions Most youth are symptom-free and fully recovered 1-year following concussion. Youth with repeat concussion have worse outcomes and delays in returning to normal school routines and sport.