Predictors of Return-to-Learn Duration After Sport-Related Concussion in Adolescent Athletes

Introduction: Sport-related concussion (SRC) is a public health concern among adolescent athletes. Return-to-learn (RTL) is an area of growing interest in the SRC literature, yet primary research regarding the topic remains limited. In a large cohort of high school athletes, we sought to 1) describe patterns of RTL, and 2) evaluate the predictors of RTL duration.

Methods: Data were obtained through a prospective SRC surveillance system across more than 30 high schools throughout the state of Maine between 09/2014-01/2023. The primary outcome was RTL, defined by the total number of days for an athlete to fully return to school without accommodations from their initial injury date. Descriptive statistics were performed. Mann-Whitney U tests were used to compare RTL duration between male and female athletes. A multivariable linear regression was performed to evaluate predictors of RTL duration. Covariates included gender, number of previous concussions, history of ADHD (attention-deficit/hyperactivity disorder), history of migraines, days to evaluation, and initial total Post-Concussion Symptom Scale (PCSS) score.

Results: A total of 895 athletes were included in the analysis (mean age=16.2±1.4, 54.5% male). The median RTL was 6 days for males [Interquartile range (IQR)=3-11) and females (IQR=3-12) (U=84,364.00, p=.375). Across all athletes, 58.9% had successfully achieved RTL by 1 week, 83.2% by 2 weeks, and 91.7% by 3 weeks. In a multivariable linear regression, greater days to evaluation (B=0.85, 95%CI: 0.13-1.56; p<.021) and higher initial total PCSS score (B=0.09, 95%CI: 0.04-0.14; p<.001) were associated with longer RTL. Gender, number of previous concussions, history of ADHD, and history of migraines were not associated with days to RTL (p>.05).

Conclusion : In a cohort of high school athletes, the median time to return-to-learn was 6 days, and 59% returned by 1 week. Greater days to evaluation and higher initial symptom burden were associated with longer time to RTL. Gender, prior concussions, and ADHD/migraines history were not associated with RTL duration.