School problems following sports concussion. Which children are at greatest risk?

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Identify risk for adverse outcomes in school performance and attendance following concussion.




Outpatient clinic, teaching hospital.


216 children ages 12–18 (mean (SD)=15.1 (1.6); 70% male) seen within 2 months of sport-related concussion (mean days since injury=21.2 (12.6)).


Predictors: Pre-injury risk/post-concussion symptoms, injury characteristics.

Main Outcome Measurements

Reported drop in grades, days of school absence.


Correlation and crosstabs revealed no association between a drop in grades and a personal or family history of developmental delays, pre-injury school performance, developmental disabilities, or previous concussions. Higher maternal education and retrospective pre-injury symptoms were significantly associated with lower grades. Total post-injury symptom burden (parent and child reported) and physical exertional symptoms were not related, although presence of amnesia/loss of consciousness and cognitive exertional effects (symptom exacerbation) were significantly associated with lower grades. No pre-injury risk factors were correlated with school absence, but symptom burden at time of injury and subsequent parent/child symptom report at time of evaluation were positively associated with number of days absent from school.


Varying post-concussion factors are related to school outcomes. Pre-injury risk factors (higher baseline symptoms, maternal education) and post-injury factors (LOC/amnesia, cognitive exertional effects) related to drop in grades. In contrast, symptom burden at injury and later severity was related to days absent from school. These findings provide the clinician with useful indicators of possible risk factors for adverse outcomes in school performance, an important issue in concussion management for children.

Competing interests


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