title: The Effect of Concussion or Mild Traumatic Brain Injury on School Grades, National Examination Scores, and School Attendance: A Systematic Review.
abstract: Concussion often results in symptoms, including difficulty concentrating, focusing, and remembering, that are typically managed with cognitive and physical rest. Often, the school environment is not conducive to cognitive rest and may lead to worsening or prolonged symptoms that can contribute to impaired academic performance. The objective of the review was to identify and summarize literature concerning the effects of concussion or mild traumatic brain injury (mTBI) on academic outcomes. MEDLINE, Embase, Scopus, and CINAHL were searched until June 1, 2016. Studies must have been primary literature examining students enrolled in primary, secondary, or post-secondary education, have received a physician diagnosis of concussion or mTBI, and have post-injury academic outcomes assessed in numeric or alphabet grade/grade point average (GPA), school attendance records, or national examination scores. Data were extracted and checked by a second reviewer for accuracy and completeness. Nine studies were included. Among four studies that examined grades, one found a significant difference in pre- and post-grades only in the subject Afrikaans. Three examined national test scores and no significant differences were found between cases and controls. Four examined school absenteeism and found that students who developed post-concussion syndrome missed significantly more school days and took longer to return to school than students with extremity injuries. Although mTBI or concussion is associated with missed school, the results demonstrate minimal impact on school grades and national examination scores at a group level. Further research is needed to identify risk factors for impaired school functioning following mTBI and concussion in individual patients.
authors.affiliation: 1 Max Rady College of Medicine, University of Manitoba , Winnipeg, Manitoba, Canada .
authors.forename: Adrian
authors.initials: A
authors.lastname: Rozbacher
authors.affiliation: 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada .|6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada .
authors.forename: Erin
authors.initials: E
authors.lastname: Selci
authors.affiliation: 2 Department of Surgery, University of Manitoba , Winnipeg, Manitoba, Canada .|5 Pan Am Concussion Program , Winnipeg, Manitoba, Canada .|7 Canada North Concussion Network , Winnipeg, Manitoba, Canada .
authors.forename: Jeff
authors.initials: J
authors.lastname: Leiter
authors.affiliation: 1 Max Rady College of Medicine, University of Manitoba , Winnipeg, Manitoba, Canada .|2 Department of Surgery, University of Manitoba , Winnipeg, Manitoba, Canada .|3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada .|4 Section of Neurosurgery, University of Manitoba , Winnipeg, Manitoba, Canada .|5 Pan Am Concussion Program , Winnipeg, Manitoba, Canada .|6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada .|7 Canada North Concussion Network , Winnipeg, Manitoba, Canada .
authors.forename: Michael
authors.initials: M
authors.lastname: Ellis
authors.affiliation: 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada .|6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada .|7 Canada North Concussion Network , Winnipeg, Manitoba, Canada .
authors.forename: Kelly
authors.initials: K
authors.lastname: Russell
mesh_terms: D000073978:Academic Performance / Q000706:statistics & numerical data*; D000293:Adolescent; D001924:Brain Concussion / Q000453:epidemiology*; D002648:Child; D006801:Humans; D012574:Schools / Q000706:statistics & numerical data*; D013334:Students / Q000706:statistics & numerical data*
keywords: academic outcomes; concussion; mild traumatic brain injury; pediatrics; systematic review