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Get Your Head In the…Classroom? Return to School After Concussion Injuries

February 28, 2023

Written by Ketan Patel

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This study supports the notion that an early return to school (RTS), results in faster recovery from concussion symptoms versus prolonged absences.

Why does this matter?
Currently, data have been sparse in quantifying concussion symptom burden and recovery in relation to RTS. Practice, therefore, has been based largely on eminence-based practice as opposed to scientific evidence; thus, large variations in RTS timing exist amongst concussion patients.

Delays are detrimental
Nine pediatric emergency departments participated in an observational cohort study analyzing the change in concussion burden (measured by the Post-Concussion Symptom Inventory (PCSI)) from the time of evaluation to 14 days post-injury. The relationship between timing of RTS and symptom burden was the primary outcome analyzed to see if correlation existed.

In their analysis across age groups, they found a trend that older children missed more days of school than younger counterparts (8-12 and 13–18-year-old groups versus 5–7-year olds). An early RTS, defined as 2 days or fewer, was associated with larger symptomatic improvement at 14 days in those 8 years or older. This correlation in improvement of symptoms at 14 days was also stronger in those kids over 8 years old with worse concussions initially.

This study certainly provides data showing a correlation between early RTS and symptomatic improvement in concussion symptoms and recovery. While this is a correlation, the causative factors associated with recovery will need to be further explored. As the authors note, numerous social, physical, psychological factors likely play a role in recovery after concussion injuries. How each of these affect recoveries, along with various accommodations to return that improve symptoms will need to be further parsed out. The impact of these factors also likely affects various age groups disproportionately, and early RTS is not likely to be universally beneficial.

Association Between Early Return to School Following Acute Concussion and Symptom Burden at 2 Weeks Postinjury. JAMA Netw Open. 2023 Jan 3;6(1):e2251839. doi: 10.1001/jamanetworkopen.2022.51839.

What are your thoughts?