Sleep Symptoms Predict School Attendance After Pediatric Concussion

Abstract

This study examined the relationship between postconcussive symptom domain and school attendance. Retrospective chart review was completed for 88 children aged 6 to 18 years who were evaluated within 30 days postinjury. Hierarchical multiple regression was used to assess the association of physical, cognitive, emotional, and sleep symptoms with extent of school attendance. A subgroup multiple regression analysis was conducted to evaluate whether age affected the relationship of symptoms to school attendance. After controlling for demographic variables and total number of symptoms, a higher number of postconcussive sleep symptoms strongly predicted less school attendance. Specifically, older children (≥14 years old) with more sleep symptoms demonstrated less school attendance. For children presenting for specialty care after concussion, sleep symptoms are unfavorably associated with return to school. Future work aimed at optimizing sleep regulation following concussion may assist with early reengagement in school as recommended by current concussion management guidelines.

Does Sleep Quality Influence Recovery Outcomes After Postconcussive Injury in Children and Adolescents?

“…In a study of 88 children and adolescents, subjective sleep symptoms were shown to be a significant predictor of postconcussion school attendance. 17 Other studies have found that children and adolescents deemed to have poor sleep quality using the Pittsburgh Sleep Quality Index took significantly longer to reach symptom resolution and to be cleared to return to play following concussion. 11 Another study found that adolescents with subjective sleep symptoms had a 3-to 4-fold increase in symptom resolution time when compared with adolescents without self-reported sleep symptoms.…”

Investigating the Student in Returning to Learn After Concussion: A Systematic Review andMeta‐Analysis

“…School attendance, evaluated as missed days of school after concussion, was reported in 20 studies. Of these, 2 focused on college students, 42,43 6 were adolescents, 16,19,[44][45][46][47] and 12 were mixedage groups. 3,[48][49][50][50][51][52][53][54][55][56][57] Absences from school ranged widely, from a mean of 3 to 69.2 days.…”

“…Academic accommodations, communication between medical providers and schools, and receiving academic accommodations and medical care, including therapy-based interventions, were positive factors for post-concussion academic experiences. 45,53,54,[66][67][68]70,73,74 However, estimates were not provided to measure the association between each post-injury factor and academic outcomes.…”

Critical Elements of Return to Learn for Students With Concussion: A Scoping Review

“…8,87 Healthcare entry points were frequent barriers. 8,14,73,84,89,117,126 Fewer than half of patients seen by a primary care physician were provided academic accommodations, 14,87 and 95% of patients seen in the emergency department were not provided accommodations. 78 physician, 105,117,127 many students appear to be at risk for not receiving accommodations.…”