Mild traumatic brain injuries (mTBI), or concussions, make up an estimated 75% of traumatic brain injuries in American children annually. The identification and management of mTBI can be difficult for students who are injured outside of school, as they may go unnoticed by standard school concussion protocols. This gap is dangerous for children who return to activities before they adequately recover, which can lead to prolonged recoveries and repeated concussions. Understanding how characteristics, such as age and sex, affect the development of concussions allows medical and educational systems to adequately support students experiencing a concussion.
Previous concussion research has largely focused on school-related injuries, especially those resulting from sports, and is often limited to high-school aged students. This leaves certain groups vulnerable to inadequate concussion identification and treatment, especially in school settings. A team of researchers studied a group of 384 elementary, middle, and high school students who received an mTBI diagnosis for four years. To identify gaps in the concussion diagnosis and treatment process, the researchers documented the nature of injury, time between injury and formal diagnosis, and other school-related measures for each student.
Their results showed that elementary and middle school students had a significantly longer time between their injury and mTBI diagnosis than high school students. Moreover, elementary and middle school female students had a significantly longer time to diagnosis after concussion than male students. Across all age groups, students with a non-school-related concussion had more absences than students who experienced their concussion during a school-related activity.
These results indicate that concussion diagnostic and treatment protocols are better adapted to high school age students than younger students. This may be attributed to the incidental finding that high schoolers were more likely to sustain head injuries during organized school sports, a setting in which concussion diagnostics are more accessible. However, it is important for schools and clinicians to identify certain characteristics—female gender, elementary/middle school age, and non-school-related concussion—as risk factors for delayed mTBI diagnosis or recovery. Educational and medical institutions should revise current mTBI/concussion protocols to support better recovery and return-to-activity for their students.
Snedaker K, Lundine J, Ciccia A, et al. Gaps in concussion management across school aged children. Brain Injury. (February 2022).