Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association.

This prospective, multicenter cohort study included participants aged 5.00–17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates.

311 children (65.0% males; median age = 11.92 [IQR = 9.14–14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ2 = 9.85, p = .043) and Verbal Fluency scores (χ2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17.

Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.

症状和认知都被用作儿童脑震荡后恢复的指标，但它们之间的相互关系尚不清楚。本研究旨在调查：1) 儿童脑震荡后 4 周和 12 周时脑震荡后症状负担与认知结果（处理速度和执行功能 [EF]）之间的关联，以及 2) 性别对这种关联的调节作用。

这项前瞻性、多中心队列研究包括年龄为 5.00-17.99 岁、患有急性脑震荡、在加拿大儿科急诊研究网络的四个急诊科就诊的参与者。脑震荡后 4 周和 12 周进行五项处理速度和 EF 任务以及脑震荡后症状量表（PCSI；症状负担，定义为受伤后和回顾性[受伤前]评分之间的差异）。采用广义最小二乘模型，以任务表现作为因变量，以 PCSI 和 PCSI*性别交互作为主要预测因子，以重要的受伤前人口统计和受伤特征作为协变量。

分析包括 311 名儿童（65.0% 为男性；中位年龄 = 11.92 [IQR = 9.14–14.21 岁]）。调整协变量后，较高的症状负担与较低的后向数字跨度（χ 2 = 9.85，p = .043）和跨时间点的言语流利度得分（χ 2 = 10.48，p = .033）相关；这些关联不受性别调节，ps ≥ .20。症状负担与编码、连续性能测试和色词干扰分数的表现无关，ps ≥ .17。

儿童脑震荡后较高的症状负担与较低的工作记忆和认知灵活性有关，但这些关联不受性别的调节。研究结果可能通过强调 EF 多方面评估的重要性来为脑震荡管理提供信息。