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Fatigue recovery and connected factors following paediatric concussion
  1. Fabian Fabiano1,
  2. Michael Takagi1,
  3. Nicholas Anderson1,
  4. Franz E Babl1,2,
  5. Silvia Bressan3,
  6. Cathriona Clarke1,
  7. Katie Davies1,
  8. Gavin A Davis1,4,
  9. Kevin Dunne1,5,
  10. Stephen Hearps1,
  11. Vera Ignjatovic6,7,
  12. Vanessa C Rausa1,
  13. Marc Seal1,
  14. Vicki Anderson1,8
  1. 1Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  2. 2Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
  3. 3Department of Women's and Children's Health, Università degli Studi di Padova, Padova, Italy
  4. 4Cabrini Health, Melbourne, Victoria, Australia
  5. 5Department of Rehabilitation, Royal Children's Hospital, Melbourne, Victoria, Australia
  6. 6Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
  7. 7Departments of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  8. 8Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Fabian Fabiano, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; fabian.fabiano{at}


Objective Using a biopsychosocial framework and the three-factor fatigue model, we aimed to (1) plot recovery of fatigue over the 3 months following paediatric concussion and (2) explore factors associated with persisting fatigue during the first 3 months postconcussion.

Methods 240 children and adolescents aged 5–18 years (M=11.64, SD=3.16) completed assessments from time of injury to 3 months postinjury. Separate linear mixed effects models were conducted for child and parent ratings on the PedsQL-Multidimensional Fatigue Scale to plot recovery across domains (General, Cognitive, Sleep/Rest) and Total fatigue, from 1 week to 3 months postinjury. Two-block hierarchical regression analyses were then conducted for parent and child ratings of fatigue at each time point, with age, sex and acute symptoms in block 1 and child and parent mental health variables added to block 2.

Results There was a significant reduction in both child and parent ratings across the 3 months postinjury for all fatigue domains (all p<0.001). For both child and parent fatigue ratings, child mental health was the most significant factor associated with fatigue at all time points. Adding child and parent mental health variables in the second block of the regression substantially increased the variance explained for both child and parent ratings of fatigue.

Conclusion Our findings confirm that fatigue improves during the first 3 months postconcussion and highlights the importance of considering child and parent mental health screening when assessing patients with persisting postconcussive symptoms.

  • Fatigue
  • Pediatrics
  • Brain Concussion
  • Child Health

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors FF drafted the initial manuscript and analysed the data, and VA drafted the initial manuscript, and conceptualised, designed, and is guarantor of the study. FEB, SB, KD, GAD, SH, VI, MS and MT conceptualised and designed the study and critically revised the manuscript for important intellectual content. NA, CC, KD and VCR made substantial contributions to the conception of the study, the acquisition of data, and critically revised the manuscript for important intellectual content. 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 Royal Children’s Hospital Research Foundation (2014-370). VA and FEB are supported by Australian National Health and Medical Research Council practitioner fellowships.

  • Disclaimer The funding organisations did not have a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.