Association Between Early Return to School Following Acute Concussion and Symptom Burden at 2 Weeks Postinjury

Abstract

ImportanceDetermining how the timing of return to school is related to later symptom burden is important for early postinjury management recommendations.ObjectiveTo examine the typical time to return to school after a concussion and evaluate whether an earlier return to school is associated with symptom burden 14 days postinjury.Design, Setting, and ParticipantsPlanned secondary analysis of a prospective, multicenter observational cohort study from August 2013 to September 2014. Participants aged 5 to 18 years with an acute (<48 hours) concussion were recruited from 9 Canadian pediatric emergency departments in the Pediatric Emergency Research Canada Network.ExposureThe independent variable was the number of days of school missed. Missing fewer than 3 days after concussion was defined as an early return to school.Main Outcomes and MeasuresThe primary outcome was symptom burden at 14 days, measured with the Post-Concussion Symptom Inventory (PCSI). Symptom burden was defined as symptoms status at 14 days minus preinjury symptoms. Propensity score analyses applying inverse probability of treatment weighting were performed to estimate the relationship between the timing of return to school and symptom burden.ResultsThis cohort study examined data for 1630 children (mean age [SD] 11.8 [3.4]; 624 [38%] female). Of these children, 875 (53.7%) were classified as having an early return to school. The mean (SD) number of days missed increased across age groups (5-7 years, 2.61 [5.2]; 8-12 years, 3.26 [4.9]; 13-18 years, 4.71 [6.1]). An early return to school was associated with a lower symptom burden 14 days postinjury in the 8 to 12-year and 13 to 18-year age groups, but not in the 5 to 7-year age group. The association between early return and lower symptom burden was stronger in individuals with a higher symptom burden at the time of injury, except those aged 5 to 7 years.Conclusions and RelevanceIn this cohort study of youth aged 5 to 18 years, these results supported the growing belief that prolonged absences from school and other life activities after a concussion may be detrimental to recovery. An early return to school may be associated with a lower symptom burden and, ultimately, faster recovery.

Exploring the association between cognitive activity and symptom resolution following concussion in adolescents aged 11–17 years

“…Consistent with recent studies,39 this study found that participants who delayed their return to school experienced longer symptom duration. Each additional day of delayed return was associated with 8% lower rate of symptom resolution.…”

The SUCCESS Peer Mentoring Program for College Students with Concussion: Preliminary Results of a Mobile Technology Delivered Intervention

“…The current results suggest that this likely extends to students with concussion, and aligns well with the needs of this group, for whom reassurance of recovery and social support are key components of care in neurobiopsychosocial models of concussion and recovery. Extended absences and removal from social groups are known to negatively affect student outcomes, especially in older students [ 69 ], so that embedding educational delivery in a social context, as was provided here, matches with student needs.…”

Precision Concussion Management: Approaches to Quantifying Head Injury Severity and Recovery

“…More recent research, however, has indicated that prolonged rest after concussion is not associated with improvement in outcomes [ 11 ]. In fact, clinical evidence has demonstrated that an early return to moderate cognitive and physical activity following a concussion is beneficial for symptom resolution and reduces the incidence of persistent post-concussion symptoms compared to prolonged rest [ 12 , 13 , 14 , 15 ]. This is just one example of how our understanding of concussion management is continuously evolving, and is an illustration of why increased precision in post-concussion care is critical to improving outcomes for patients with head injuries.…”