Recovery From Adolescent Sports Concussion During the School Year Compared With Summer

Adolescents with acute concussion may experience increased symptoms when returning to school. We sought to compare time to concussion resolution during the academic school year and summer break.

This retrospective chart review assessed adolescents aged 13-18 years presenting within 14 days of concussion to an outpatient sports medicine clinic. The primary outcome was days to concussion resolution. Participants were categorized into "school" or "summer" groups based on the timing of their concussion in relation to local school calendars.

A total of 2500 patients (42% female) were included: 2371 with school concussion and 129 with summer concussion. By the first clinic visit (median: 5-6 days), median symptom score in the school group was twice that of the summer group (16 vs 8). Median days to resolution differed (P < 0.001) between the school group (15 days, 95% confidence interval [CI]: 15-16) and the summer group (12 days, 95% CI: 11-14). Earlier concussion resolution was associated with injury during the summer (hazard ratio: 1.51, 95% CI: 1.25-1.82, P < 0.001, when controlling for other variables). Longer concussion resolution was associated with female sex, greater symptoms on the day of injury, two or more previous concussions, and amnesia. Somatic, cognitive, and sleep symptoms were higher in the school group (all P < 0.05), whereas emotional symptoms did not differ between groups.

Adolescents take longer to recover from concussion during the school year. Academic accommodations may not be sufficient to normalize recovery time. Earlier management, as well as treatments targeting somatic, cognitive, and sleep symptoms, should be offered.