Research Article: Academic outcomes following adolescent sport-related concussion or fracture injury: A prospective cohort study

Date Published: April 25, 2019

Publisher: Public Library of Science

Author(s): Kelly Russell, Erin Selci, Brian Black, Karis Cochrane, Michael Ellis, James J. Cray.


The objectives were 1) to compare the effects of adolescent sport-related concussion (SRC) and sport-related extremity fracture (SRF) on academic outcomes including change in school grades and school attendance; and 2) to determine which specific academic accommodations were most helpful during recovery from these injuries.

A prospective cohort study was conducted to compare changes in school grades, school attendance and academic accommodations among students (grades 8–12) with an SRC or SRF. School grades were extracted from student immediate pre- and post-injury report cards. Students completed attendance log books and an exit interview to determine which accommodations were helpful and how accommodating they perceived their school to be during their recovery.

Overall, 124 students (92 with SRC and 32 with SRF) submitted both pre- and post-injury report cards. Students who sustained an SRC or SRF experienced similar decreases in grades post-injury (SRC: -1.0%; 95% CI: -2.1, 0.1 and SRF: -0.9%: 95% CI: -2.1, 0.3). Students with an SRC missed significantly more days of school compared to those with an SRF (median of 4 days [IQR: 1, 7] versus 1 day [IQR: 0, 4], p<0.0001). In total, 60/113 (53.1%) SRC students reported their school to be very accommodating while only 31/77 (40.3%) SRF students reported their school to be very accommodating (p = 0.082). Students who sustain an SRC miss significantly more days of school but demonstrate similar changes in school grades post-injury compared to those with an SRF. Future studies are needed to identify the pre- and post-injury factors associated with poor academic functioning following concussion and identify measures that can be taken to help optimize academic outcomes in these patients.

Partial Text

Concussion is the most common form of traumatic brain injury (TBI) and is associated with a rapid onset of neurological symptoms that typically resolve spontaneously [1]. Children and adolescents often experience symptomatic recovery within weeks post-injury; however, approximately 30% develop persistent post-concussion symptoms lasting longer than 1 month [2,3]. Persistent post-concussion symptoms can manifest as headaches, dizziness, visual disturbance, or difficulties with memory and concentration that can have a negative impact on patient functioning and health-related quality of life [4–6]. These symptoms can also negatively impact school performance.

In total, 250 students were recruited; however, 19 students were excluded because they attended only their first appointment. Of the 231 students, an additional 27 were lost to follow-up and one student sustained a second injury while recovering from their first and was subsequently excluded. Thus, there were 203 students included in the study who completed school attendance data. The median time from injury to initial assessment was 6 days (IQR: 5, 10) for SRC students and 9 days (IQR: 7, 12) for SRF students (p = 0.090). The median time to physician-documented clinical recovery was 26 days (IQR: 17, 43) for SRC students and 31 days (IQR: 23, 42) for SRF students (p = 0.128).

This study provides novel insight into the effect of SRC on objective academic outcomes including school grades and attendance and highlights specific academic accommodations that can benefit students recovering from this injury.




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