Early Psychological Intervention Embedded in a Pediatric Concussion Program: A Retrospective Cohort Study

Objective To compare outcomes among children and youth (3-21 years) with post-concussion syndrome (PCS) who received early (≤8 days) embedded psychological intervention (EI) after the index visit with those who received usual care (UC) in a pediatric concussion program. Methods Retrospective cohort study at the Boston Medical Center Concussion Clinic (2015-2024) including 56 patients (EI n = 28; UC n = 28). Outcomes were follow-up time and recovery status at last follow-up. Mann-Whitney U and Fisher exact tests were used, with effect sizes (| r | and odds ratio [OR]). Results Follow-up time was shorter in EI ( P < .001; | r |=0.72). Recovery was higher in EI (57.1% vs 10.7%; OR 10.58, 95% CI 2.40-67.50; P = .005). Between-group differences persisted in a sensitivity analysis restricted to UC participants without major neurologic or neurodevelopmental complexity; the association with recovery remained significant after adjustment (aOR 10.14, 95% CI 1.25-226.95; P = .048). Conclusion Early embedded psychological intervention was associated with improved recovery outcomes in pediatric PCS.