Although there is a large body of research on mild traumatic brain injury (MTBI), the portion that pertains to acute patients (those less than 1 month postinjury) is relatively small and yields inconsistent findings. The potential contribution of non-neurological factors, such as pain and emotional distress, to the clinical picture in this population is also lacking. To address these issues, the cognitive performance and symptom complaints of 37 hospitalized MTBI subjects were compared to those of 39 hospitalized trauma subjects, averaging 4.5 days postinjury. MTBI subjects performed significantly worse on all cognitive measures, but did not differ from trauma subjects in their report of postconcussive symptoms. Analyses also revealed that cognitive performance was unrelated to pain severity and emotional distress. Postconcussive symptoms were similarly unrelated to pain severity, but were consistently related to emotional distress. Results are discussed in terms of their etiological and treatment implications.