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Roberts J, Wilson JC, Halstead ME, Miller SM, Santana JA, Valovich McLeod TC, Zaslow TL, Master CL, Grady MF, Snedden TR, Fazekas ML, Coel RA, Howell DR. Variables associated with days of school missed following concussion: results from the Sport Concussion Outcomes in PEdiatrics (SCOPE) study. PHYSICIAN SPORTSMED 2024:1-9. [PMID: 38648009 DOI: 10.1080/00913847.2024.2344435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To understand factors associated with missed academic time after concussion to improve support for patients. Our goal was to assess patient-specific predictors of total school time lost after pediatric/adolescent concussion. STUDY DESIGN We performed a prospective cohort study of children and adolescents (8-18 years of age) seen within 14 days of concussion from seven pediatric medical centers across the United States. We collected outcomes via the Concussion Learning Assessment & School Survey (CLASS) and constructed a multivariable predictive model evaluating patient factors associated with school time loss. RESULTS 167 patients participated (mean age = 14.5 ± 2.2 years; 46% female). Patients were assessed initially at 5.0 ± 3.0 days post-injury and had a final follow-up assessment 24.5 ± 20.0 days post-concussion. Participants missed a median of 2 days of school (IQR = 0.5-4), and 21% reported their grades dropped after concussion. Higher initial symptom severity rating (β = 0.06, 95% CI = 0.03-0.08, p < 0.001) and perception of grades dropping after concussion (β = 1.37, 95% CI = 0.28-2.45, p = 0.01) were significantly associated with more days of school time missed after concussion. Those who reported their grades dropping reported missing significantly more school (mean = 5.0, SD = 4.7 days missed of school) than those who reported their grades did not drop (mean = 2.2, SD = 2.6 days missed of school; p < 0.001; Cohen's d = 0.87). CONCLUSIONS Children and adolescents reported missing a median of 2 days of school following concussion, and more missed school time after a concussion was associated with more severe concussion symptoms and perception of grades dropping. These findings may support recommendations for minimal delays in return-to-learn after concussion.
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Affiliation(s)
- Jeremy Roberts
- Sports Medicine Center, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark E Halstead
- School of Medicine, Departments of Orthopedics and Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Shane M Miller
- Scottish Rite for Children and UT Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan A Santana
- Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Tracy L Zaslow
- Cedars Sinai Kerlan Jobe Institute, Los Angeles, CA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Matthew F Grady
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Traci R Snedden
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | | | - Rachel A Coel
- Kapi'olani Medical Center for Women and Children, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
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McLarnon M, Heron N. How to identify and manage sports related concussions in primary care. BMJ 2023; 382:e073161. [PMID: 37722751 DOI: 10.1136/bmj-2022-073161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
| | - Neil Heron
- Centre for Public Health, Queen's University Belfast, Belfast
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
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Lystad RP, McMaugh A, Herkes G, Browne G, Badgery-Parker T, Cameron CM, Mitchell RJ. Risk of impaired school performance in children hospitalized with concussion: a population-based matched cohort study. Concussion 2023; 8:CNC105. [PMID: 37691853 PMCID: PMC10488614 DOI: 10.2217/cnc-2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/21/2023] [Indexed: 09/12/2023] Open
Abstract
Aim To examine the impact of concussion on objective measures of school performance. Materials & methods Population-based matched cohort study using linked health and education records of young people aged ≤18 years hospitalized with concussion in New South Wales, Australia, during 2005-2018, and matched comparisons not hospitalized with any injury. Results Young people with concussion had higher risk of not achieving the national minimum standards for literacy and numeracy assessments, ranging from 30% for numeracy to 43% for spelling, and not completing high school, ranging from 29% for year 10 to 77% for year 12, compared with matched peers. Conclusion Young people hospitalized with concussion have impaired school performance compared with uninjured matched peers.
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Affiliation(s)
- Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park NSW, 2109, Australia
| | - Anne McMaugh
- The Macquarie School of Education, Macquarie University, Macquarie Park NSW, 2109, Australia
| | - Geoffrey Herkes
- Sydney Medical School, University of Sydney, Camperdown NSW, 2006, Australia
- Royal North Shore Hospital, St Leonards NSW, 2065, Australia
| | - Gary Browne
- Sydney Medical School, University of Sydney, Camperdown NSW, 2006, Australia
- The Children's Hospital at Westmead, Westmead NSW, 2145, Australia
| | - Tim Badgery-Parker
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park NSW, 2109, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Metro North Health, Herston QLD, 4029, Australia
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane QLD, 4000, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park NSW, 2109, Australia
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Dawson J, Johnston S, McFarland S, Reed N, Zemek R. Retour à l’école après une commotion cérébrale. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:e120-e123. [PMID: 37315965 PMCID: PMC10266391 DOI: 10.46747/cfp.6906e120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Jennifer Dawson
- Associée de recherche à l'Institut de recherche du Centre hospitalier pour enfants de l'est de l'Ontario à Ottawa (Ontario)
| | - Sharon Johnston
- Vice-présidente agrégée de la recherche à l'Institut du Savoir Montfort à Ottawa et clinicienne chercheuse au Département de médecine familiale de l'Université d'Ottawa
| | - Stephanie McFarland
- Clinicienne responsable et ergothérapeute spécialisée en commotions et lésions cérébrales pédiatriques au Holland Bloorview Kids Rehabilitation Hospital à Toronto (Ontario)
| | - Nick Reed
- Professeur agrégé au Département des sciences du travail et de l'ergothérapie de l'Université de Toronto et titulaire de la Chaire de recherche du Canada sur les commotions cérébrales en pédiatrie (niveau 2)
| | - Roger Zemek
- Professeur au Département de pédiatrie et de médecine d'urgence et clinicien chercheur en commotions cérébrales pédiatriques à l'Université d'Ottawa, et directeur de l'Unité de recherche clinique au Centre hospitalier pour enfants de l'est de l'Ontario.
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Tang AR, Davis PJ, Williams KL, Grusky AZ, Hajdu KS, Hou BQ, Yengo-Kahn AM, Zuckerman SL, Terry DP. Use of acute cognitive symptom cluster to predict return-to-learn duration following a sport-related concussion. J Neurosurg Pediatr 2022; 30:378-385. [PMID: 35907196 DOI: 10.3171/2022.6.peds22182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Adolescents sustaining sport-related concussion often experience difficulties with the return-to-learn (RTL) process. Whereas the initial symptom burden has predicted prolonged RTL, no studies have established a relationship between acute cognitive symptoms and RTL duration. The authors sought to evaluate the relationship between initial cognitive symptoms and RTL duration. METHODS A retrospective single-institution cohort study of adolescent athletes aged 12-23 years who were evaluated within 5 days of a diagnosed sport-related concussion between November 2017 and October 2020 was conducted. Athletes missing cognitive symptom ratings and RTL data were excluded. The primary exposure variable was the Cognitive Symptom Ratio (CSR), defined as total cognitive symptom cluster score divided by total Post-Concussion Symptom Scale (PCSS) score from the initial clinic visit. Primary and secondary outcomes were time to RTL and total length of care, respectively. Multivariable Cox proportional hazards modeling was used to assess the effect of CSR on RTL duration. RESULTS Of 653 athletes evaluated within 5 days of injury, 346 patients were included in the final cohort. Athletes reported a median initial PCSS score of 21 (interquartile range [IQR] 6-37) and a median cognitive symptom score of 4 (IQR 0-9). Most patients endorsed some degree of difficulty concentrating (n = 212, 61.3%). The median CSR was 0.18 (IQR 0.00-0.27). On multivariable regression analysis, a higher CSR was associated with prolonged RTL duration (HR 0.30, 95% CI 0.13-0.69, p = 0.004). When initial PCSS score was added to the model, the previously significant association between CSR and RTL was no longer significant (HR 0.67, 95% CI 0.29-1.59, p = 0.367). When dichotomized based on frequency distribution, a higher proportion of patients with low CSR achieved RTL by 7 days postinjury (82.2% vs 69.9%, p = 0.007), a difference not seen at 14 days (92.2% vs 87.3%, p = 0.133). CONCLUSIONS An acute ratio of cognitive symptoms may predict patients at increased risk for prolonged RTL and those with normal PCSS scores who may experience difficulties once resuming school activities.
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Affiliation(s)
- Alan R Tang
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Philip J Davis
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Kristen L Williams
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan Z Grusky
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Katherine S Hajdu
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Brian Q Hou
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Aaron M Yengo-Kahn
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Zuckerman
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas P Terry
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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