School Attendance and Symptoms in Adolescents After Sport-Related Concussion

Abstract

Despite this, however, symptom severity score increased with hours of school (β = 0.32, P < .0137), with no significant effects of days from injury (β = −2.12, P = .50). Fast, moderate, or delayed recovery speed groups (P = .44) did not moderate the relationship between school hours and symptoms. When selecting out 3 students with low initial symptom scores and only one day of school, we observed similar effects for hours of school (β = 0.37, P < .0101) and time (β = −2.24, P < .001). Figure 2 shows that hours of school increased with days from injury. Discussion Our data show that, controlling for time from injury and speed of recovery, hours of school attendance exacerbated symptoms in adolescents after SRC. To our knowledge , this is the first prospective study that used daily symptom reports to show that school attendance exacerbated symptoms in adolescents after SRC. This has implications with respect to monitoring and modifying school hours after SRC in adolescents. What do these findings mean for clinicians? Each case of SRC is individualized and unique. There are no evidence-based guidelines in place for return to school postconcussion. Clinicians currently rely on the history, physical examination, and other diagnostic studies to decide on an appropriate treatment plan after concussion. Some adolescents may be able to return to school immediately while others may require some time off. Our results suggest that too many hours of school initially after a concussion may be detrimental to recovery. At the same time, given that the relationship we found was a weak one, we cannot definitively say that it is good practice to keep students out of school for a long period of time. The decision to remove a student from school should be based on the level of symptoms reported early after concussion 2 and whether there are physical examination findings such as significant vision dysfunction that would interfere with classroom performance and ability to read and use a computer. 10 There were limitations to our study. For one, we did not include the subjects who did not attend school because the analysis required at least some school attendance. Those students may have been the most severely injured. We did not know specifically why students did not attend school or had decreased hours. Finally, we had no information about symptoms and time in school prior to the students' first clinic visit. Nevertheless, even though the complex nature of our data collection and analytic methods may have weakened our findings, there was still a direct relationship between hours of school attended and increased symptoms. These results point to the need for larger prospective studies that examine more closely which specific school activities exacerbate symptoms and potentially delay recovery after SRC. AYM: Contributed to conception and design; contributed to acquisition, analysis, and interpretation; drafted manuscript; critically revised manuscript; gave final approval; agrees to be accountable for all aspects of work ensuring integrity and accuracy. Figure 1. Sport Concussion Assessment Tool-2 (SCAT-2) Symptom Severity scores and days postinjury for concussed adolescents who attended school (holidays and weekends are not included). Figure 2. Hours of school attended and days postinjury for concussed adolescents who attended school (holidays and weekends are not included).