Association Between Early Return to School Following Acute Concussion and Symptom Burden at 2 Weeks Postinjury.

Autor:	Vaughan CG; Division of Neuropsychology, Children's National Hospital, Washington, DC., Ledoux AA; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada., Sady MD; Division of Neuropsychology, Children's National Hospital, Washington, DC., Tang K; Independent Statistical Consultant, Richmond, British Columbia, Canada., Yeates KO; Department of Psychology, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada., Sangha G; Department of Pediatrics, Children's Hospital of Western Ontario, Western University, London, Ontario, Canada., Osmond MH; Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada., Freedman SB; Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada., Gravel J; Department of Pediatric Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada., Gagnon I; Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.; School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada., Craig W; Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada., Burns E; Department of Emergency Medicine, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada., Boutis K; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada., Beer D; Department of Pediatrics, Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada., Gioia G; Division of Neuropsychology, Children's National Hospital, Washington, DC., Zemek R; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.; Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2023 Jan 03; Vol. 6 (1), pp. e2251839. Date of Electronic Publication: 2023 Jan 03.
DOI:	10.1001/jamanetworkopen.2022.51839
Abstrakt:	Importance: Determining how the timing of return to school is related to later symptom burden is important for early postinjury management recommendations. Objective: To examine the typical time to return to school after a concussion and evaluate whether an earlier return to school is associated with symptom burden 14 days postinjury. Design, Setting, and Participants: Planned secondary analysis of a prospective, multicenter observational cohort study from August 2013 to September 2014. Participants aged 5 to 18 years with an acute (<48 hours) concussion were recruited from 9 Canadian pediatric emergency departments in the Pediatric Emergency Research Canada Network. Exposure: The independent variable was the number of days of school missed. Missing fewer than 3 days after concussion was defined as an early return to school. Main Outcomes and Measures: The primary outcome was symptom burden at 14 days, measured with the Post-Concussion Symptom Inventory (PCSI). Symptom burden was defined as symptoms status at 14 days minus preinjury symptoms. Propensity score analyses applying inverse probability of treatment weighting were performed to estimate the relationship between the timing of return to school and symptom burden. Results: This cohort study examined data for 1630 children (mean age [SD] 11.8 [3.4]; 624 [38%] female). Of these children, 875 (53.7%) were classified as having an early return to school. The mean (SD) number of days missed increased across age groups (5-7 years, 2.61 [5.2]; 8-12 years, 3.26 [4.9]; 13-18 years, 4.71 [6.1]). An early return to school was associated with a lower symptom burden 14 days postinjury in the 8 to 12-year and 13 to 18-year age groups, but not in the 5 to 7-year age group. The association between early return and lower symptom burden was stronger in individuals with a higher symptom burden at the time of injury, except those aged 5 to 7 years. Conclusions and Relevance: In this cohort study of youth aged 5 to 18 years, these results supported the growing belief that prolonged absences from school and other life activities after a concussion may be detrimental to recovery. An early return to school may be associated with a lower symptom burden and, ultimately, faster recovery.
Databáze:	MEDLINE
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