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Concussion and Academic Impairment Among U.S. High School Students

      Introduction

      Sports and physical activities are a frequent cause of traumatic brain injury, primarily concussions, among adolescents. These concussions may adversely affect students’ ability to learn and impair academic achievement in educational settings.

      Methods

      The 2017 Youth Risk Behavior Survey, conducted among a nationally representative sample of 14,765 U.S. high school students, was analyzed in 2018 to examine associations between self-reported sports- and physical activity-related concussions and symptoms of cognitive impairment (difficulty concentrating, remembering, or making decisions) and self-reported academic grades (mostly A's=4.0, mostly B's=3.0, mostly C's=2.0, mostly D's=1.0, mostly F's=0.0). Adjusted prevalence ratio and the difference in self-reported estimated grade point average were adjusted for sex, race/ethnicity, grade, and athlete status (participation on sports teams) and considered statistically significant if p<0.05.

      Results

      Male students were more likely than female students (17.1% vs 13.0%), and athletes were more likely than nonathletes (21.4% vs 7.6%) to have a self-reported sports- and physical activity-related concussion in the 12 months preceding the survey. Students with a reported sports- and physical activity-related concussion were more likely than students without one to report symptoms of cognitive impairment regardless of whether they were male (adjusted prevalence ratio=1.49), female (adjusted prevalence ratio=1.37), athletes (adjusted prevalence ratio=1.45), or nonathletes (adjusted prevalence ratio=1.42). Self-reported grade point averagedecreased significantly from 3.14 among students who reported no concussions (referent), to 3.04 among students who reported a single concussion, and 2.81 among students who reported ≥2 concussions.

      Conclusions

      School-based programs are needed to monitor students’ academic performance and provide educational support and resources to promote academic success following a concussion.
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      REFERENCES

        • Taylor CA
        • Bell JM
        • Breiding MJ
        • Xu L
        Traumatic brain injury–related emergency department visits, hospitalizations, and deaths — United States, 2007 and 2013.
        MMWR Surveill Summ. 2017; 66: 1‒16
        • CDC
        Report to Congress: the Management of Traumatic Brain Injury in Children.
        National Center for Injury Prevention and Control, Division of Unintentional Injury, Atlanta, GA2018
        • Coronado VG
        • Haileyesus T
        • Cheng TA
        • et al.
        Trends in sports- and recreation-related traumatic brain injuries treated in us emergency departments: the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) 2001‒2012.
        J Head Trauma Rehabil. 2015; 30: 185‒197
        • Arbogast KB
        • Curry AE
        • Pfeiffer MR
        • et al.
        Point of health care entry for youth with concussion within a large pediatric care network.
        JAMA Pediatr. 2016; 170e160294
        • Cassidy JD
        • Carroll LJ
        • Peloso PM
        • et al.
        Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO collaborating centre task force on mild traumatic brain injury.
        J Rehabil Med. 2004; 36: 28‒60
        • Kirkwood MW
        • Yeates KO
        • Taylor HG
        • Randolph C
        • McCrea M
        • Anderson VA
        Management of pediatric mild traumatic brain injury: a neuropsychological review from injury through recovery.
        Clin Neuropsychol. 2008; 22: 769‒800
        • Schootman M
        • Fuortes LJ.
        Ambulatory care for traumatic brain injuries in the US, 1995-1997.
        Brain Inj. 2000; 14: 373‒381
        • Marar M
        • McIlvain NM
        • Fields SK
        • Comstock RD
        Epidemiology of concussions among United States high school athletes in 20 sports.
        Am J Sports Med. 2012; 40: 747‒755
        • Rechel JA
        • Yard EE
        • Comstock RD
        An epidemiologic comparison of high school sports injuries sustained in practice and competition.
        J Athl Train. 2008; 43: 197-204
        • Ewing-Cobbs L
        • Prasad MR
        • Kramer L
        • et al.
        Late intellectual and academic outcomes following traumatic brain injury sustained during early childhood.
        J Neurosurg. 2006; 105: 287‒296
        • Moser RS
        • Schatz P
        • Jordan BD
        Prolonged effects of concussion in high school atheletes.
        Neurosurgery. 2005; 57: 300-306
        • Ransom DM
        • Vaughan CG
        • Pratson L
        • Sady MD
        • McGill CA
        • Gioia GA
        Academic effects of concussion in children and adolescents.
        Pediatrics. 2015; 135: 1043‒1050
        • Ransom DM
        • Burns AR
        • Youngstrom EA
        • Vaughan CG
        • Sady MD
        • Gioia GA
        Applying an evidence-based assessment model to identify students at risk for perceived academic problems following concussion.
        J Int Neuropsychol Soc. 2016; 22: 1038‒1049
        • Wasserman EB
        • Bazarian JJ
        • Mapstone M
        • Block R
        • van Wijngaarden E
        Academic dysfunction after a concussion among US high school and college students.
        Am J Public Health. 2016; 106: 1247‒1253
        • Donders J
        Academic placement after traumatic brain injury.
        J Sch Psychol. 1994; 32: 53‒65
        • Ewing-Cobbs L
        • Fletcher JM
        • Levin HS
        • Iovino I
        • Miner ME
        Academic achievement and academic placement following traumatic brain injury in children and adolescents: a two-year longitudinal study.
        J Clin Exp Neuropsychol. 1998; 20: 769‒781
        • Kinsella GJ
        • Prior M
        • Sawyer M
        • et al.
        Predictors and indicators of academic outcome in children 2 years following traumatic brain injury.
        J Int Neuropsychol Soc. 1997; 3: 608‒616
        • Perrott SB
        • Taylor HG
        • Montes JL
        Neuropsychological sequelae, familial stress, and environmental adaptation following pediatric head injury.
        Dev Neuropsychol. 1991; 7: 69‒86
        • Bigler ED.
        Neuropsychology and clinical neuroscience of persistent post-concussive syndrome.
        J Int Neuropsychol Soc. 2008; 14: 1‒22
        • Lundin A
        • de Boussard C
        • Edman G
        • Borg J
        Symptoms and disability until 3 months after mild TBI.
        Brain Inj. 2006; 20: 799‒806
        • Treble-Barna A
        • Schultz H
        • Minich N
        • et al.
        Long-term classroom functioning and its association with neuropsychological and academic performance following traumatic brain injury during early childhood.
        Neuropsychology. 2017; 31: 486‒498
        • Collins MW
        • Lovell MR
        • McKeag DB
        Current issues in managing sports-related concussion.
        JAMA. 1999; 282: 2283‒2285
        • Guskiewicz KM
        • Ross SE
        • Marshall SW
        Postural stability and neuropsychological deficits after concussion in collegiate athletes.
        J Athl Train. 2001; 36: 263-273
        • Rozbacher A
        • Selci E
        • Leiter J
        • Ellis M
        • Russell K
        The effect of concussion or mild traumatic brain injury on school grades, national examination scores, and school attendance: a systematic review.
        J Neurotrauma. 2017; 34: 2195‒2203
        • Russell K
        • Hutchison MG
        • Selci E
        • Leiter J
        • Chateau D
        • Ellis MJ
        Academic outcomes in high-school students after a concussion: a retrospective population-based analysis.
        PLOS ONE. 2016; 11e0165116
        • Kann L
        • McManus T
        • Harris WA
        • et al.
        Youth risk behavior surveillance – United States, 2017.
        MMWR Surveill Summ. 2018; 67: 1‒114
        • Brener ND
        • Kann L
        • et al.
        • Centers for Disease Control and Prevention (CDC)
        Methodology of the youth risk behavior surveillance System—2013.
        MMWR Recomm Rep. 2013; 62: 1-20
        www.cdc.gov/mmwr/pdf/rr/rr6201.pdf
        Date accessed: August 16, 2019
        • Crockett LJ
        • Schulenberg JE
        • Petersen AC
        Congruence between objective and self-report data in a sample of young adolescents.
        J Adolesc Res. 1987; 2: 383‒392
        • Sticca F
        • Goetz T
        • Bieg M
        • Hall NC
        • Eberle F
        • Haag L
        Examining the accuracy of students’ self-reported academic grades from a correlational and a discrepancy perspective: evidence from a longitudinal study.
        PLOS ONE. 2017; 12e0187367
      1. Sanchez E, Buddin R. How accurate are the self-reported high school courses, course grades, and grade point average? ACT Research Report Series. Iowa City, IA: American College Testing Program; 2011--32.

        • Lumba-Brown A
        • Yeates KO
        • Sarmiento K
        • et al.
        Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children.
        JAMA Pediatr. 2018; 172e182853
        • McCrea M
        • Manley G.
        State of the science on pediatric mild traumatic brain injury: progress toward clinical translation.
        JAMA Pediatr. 2018; 172e182846
        • Barlow KM
        • Crawford S
        • Stevenson A
        • Sandhu SS
        • Belanger F
        • Dewey D
        Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury.
        Pediatrics. 2010; 126: e374‒e381
        • Kurowski BG
        • Hugentobler J
        • Quatman-Yates C
        • et al.
        Aerobic exercise for adolescents with prolonged symptoms after mild traumatic brain injury: an exploratory randomized clinical trial.
        J Head Trauma Rehabil. 2017; 32: 79‒89
        • Leddy JJ
        • Haider MN
        • Hinds AL
        • Darling S
        • Willer BS
        A preliminary study of the effect of early aerobic exercise treatment for sport-related concussion in males.
        Clin J Sport Med. 2019; 29: 353-360
        • Institute of Medicine, National Research Council
        Sports-Related Concussions in Youth: Improving the Science, Changing the Culture.
        National Academies Press, Washington, DC2014
        • CDC
        Sports-related recurrent brain injuries – United States.
        MMWR Morb Mortal Wkly Rep. 1997; 46: 224-227
        • Haarbauer-Krupa J
        • Lee AH
        • Bitsko RH
        • Zhang X
        • Kresnow-Sedacca MJ
        Prevalence of parent-reported traumatic brain injury in children and associated health conditions.
        JAMA Pediatr. 2018; 172: 1078‒1086
        • Zemek RL
        • Farion KJ
        • Sampson M
        • McGahern C
        Prognosticators of persistent symptoms following pediatric concussion: a systematic review.
        JAMA Pediatr. 2013; 167: 259‒265
        • Brener ND
        • Kann L
        • McManus T
        • Kinchen SA
        • Sundberg EC
        • Ross JG
        Reliability of the 1999 Youth Risk Behavior Survey questionnaire.
        J Adolesc Health. 2002; 31: 336-342
        • McCrory P
        • Meeuwisse W
        • Johnston K
        • et al.
        Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. 3rd International Conference on Concussion in Sport Held in Zurich.
        Br J Sports Med. 2009; 43: i76‒i90