Predictors of recommended academic adjustments among concussed student-athletes presenting to the primary care setting

Objective The purpose was to describe academic ajdustments recommended by primary care physicians to paediatric concussion patients and to identify predictors of recommended adjustments. Design Prospective cohort. Setting Primary care sports medicine clinic. Subjects Participants were 8–18 years old, injured during organised or recreational sports, and presented to the clinic within 3 days of concussion. Intervention Symptom scores, average visual near-point convergence, and ImPACT composite scores were evaluated as predictors of accommodations using logistic regression. Outcome measures Academic adjustment information was obtained from a standardised, provider completed form. Patients with no recommendation form were excluded (N=31). Academic accommodations were grouped into: 1) cognitive (e.g. limited or no testing, extra time for schoolwork) and 2) visual-vestibular (e.g. auditory participation only, limited visual stimulants). Results 163 patients met the inclusion criteria; 88 (54%) were male. The mean age was 14.3±2.2 years. Most patients received academic adjustment recommendations (N=140; 86%). 21 (13%) received cognitive recommendations, 13 (8%) visual-vestibular, and 105 (64%) both. The most common recommendations were: “Take rest breaks during the day as needed” (N=108, 66%), “Patient is to limit visual stimulants and screen time” (N=102, 63%), and “Allow extra time to complete tasks” (N=97, 60%). Patients with higher symptom scores (OR=1.03 per 1-point increase; 95% CI: 1.00–1.05; p=0.03) and lower processing speed scores (OR=1.07 per 1-point decrease; 95% CI: 1.01–1.13; p=0.02) were more likely to receive visual-vestibular accommodations. There were no significant predictors of cognitive adjustments. Conclusions Most student-athletes received academic adjustment recommendations. Symptom and neurocognitive measures may aid clinicians in decision-making about academic adjustments. Competing interests Study funded in part by a research grant from the National Operating Committee on Standards for Athletic Equipment. Ms. Fonseca is employed at the study setting. Ms. Phillips is employed at the study setting. Dr. Bloom is employed at the study setting.