Category: Brain Injury; Pediatric Rehabilitation
Objective : To evaluate the impact of post-concussive symptom domain (physical, cognitive, emotional, sleep) on school attendance.
Design : Retrospective chart review.
Setting : Interdisciplinary concussion clinic at an academically affiliated rehabilitation center.
Participants (or Animals, Specimens, Cadavers) : Children aged 6-18 years (n=137; mean 13.6 years old; 54%
Interventions : Not applicable.
Main Outcome Measure(s) : School attendance was examined at the time of the initial clinic visit. Univariate regressions identified significant demographic and symptom variables for multivariate regressions. Continuous and binary multiple logistic regression models were used to predict the primary outcome measure, school attendance (no school, part-time school, full-time school with accommodations, or full-time school). A subgroup analysis investigated the impact of age on the relationship of symptoms to school attendance.
Results : In multivariate models, higher number (β=-.801, p=.016; overall model R2 =.167) and presence of sleep symptoms (β=-1.135, p=.015; overall model R2=.168) strongly predicted less school attendance. No other symptom domains were significantly related to school attendance. Older children (≥ 14 years) with higher number (β=-1.199, p=.014) and presence (β=-1.482, p=.023) of sleep symptoms demonstrated less school attendance while there was no relationship between symptom domain and school attendance in younger (<14 years) children.
For children presenting for specialty care after concussion, sleep symptoms negatively impact return to school. While physical and cognitive symptoms may be most distressing to families,1,2 sleep symptoms are often amenable to clinical management,3,4 and addressing sleep symptoms may facilitate school attendance. Future work aimed at optimizing sleep regulation following concussion may assist with early re-engagement in school as recommended by current concussion management guidelines.5
Ghazala Saleem– Postdoctoral Research Fellow, Kennedy Krieger Institute/Johns Hopkins University School of Medicine, Clarksville, Maryland
Beth Slomine– Clinical Neuropsychologist, Kennedy Krieger Institute, Baltimore, Maryland
Stacy Suskauer– Associate Professor, Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland