{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T22:14:28Z","timestamp":1777414468651,"version":"3.51.4"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Return-to-learn (RTL) after sport-related concussion (SRC) is an important yet understudied topic. The authors sought to do the following: 1) describe patterns of RTL among athletes by school level (i.e., middle school, high school, college); and 2) evaluate the predictive value of school level on RTL duration.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective, single-institution cohort study of adolescent and young adult athletes 12\u201323 years old who sustained an SRC between November 2017 and April 2022 and who presented to a multidisciplinary specialty concussion clinic was conducted. The independent variable was school level, trichotomized into middle school, high school, and college. Time to RTL was the primary outcome and was defined as days from SRC to return to any academic activities. ANOVA was used to compare RTL duration across school levels. A multivariable linear regression was performed to evaluate for predictive value of school level on RTL duration. Covariates included the following: sex, race\/ethnicity, learning disorder, psychiatric conditions, migraines, family history of psychiatric conditions\/migraines, initial Post-Concussion Symptom Scale score, and number of prior concussions.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of 1007 total athletes, 116 (11.5%) were in middle school, 835 (83.0%) were in high school, and 56 (5.6%) were in college. The mean RTL times (in days) were as follows: 8.0 \u00b1 13.1 (middle school), 8.5 \u00b1 13.7 (high school), and 15.6 \u00b1 22.3 (college). One-way ANOVA showed a statistically significant difference between groups (F[2, 1007] = 6.93, p = 0.001). A Tukey post hoc test revealed a longer RTL duration in collegiate athletes when compared to middle school (p = 0.003) and high school (p &lt; 0.001) athletes. Collegiate athletes had longer RTL duration compared to other school levels (\u03b2 = 0.14, p &lt; 0.001). There was no difference between middle school and high school athletes (p = 0.935). The subanalysis revealed a longer RTL duration in high school freshmen\/sophomores (9.5 \u00b1 14.9 days) when compared to juniors\/seniors (7.6 \u00b1 12.6 days; t = 2.05, p = 0.041), and being an older (junior\/senior) high school athlete was predictive of shorter RTL duration (\u03b2 = \u22120.11, p = 0.011).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>When examining patients who presented to a multidisciplinary sport concussion center, RTL duration was longer in collegiate athletes when compared to middle and high school athletes. Younger high school athletes had longer time to RTL compared to their older counterparts. This study provides insight into how varying scholastic environments may contribute to RTL.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.3.peds2312","type":"journal-article","created":{"date-parts":[[2023,5,6]],"date-time":"2023-05-06T16:59:38Z","timestamp":1683392378000},"page":"125-132","source":"Crossref","is-referenced-by-count":7,"title":["Return-to-learn after sport-related concussion: does school level matter?"],"prefix":"10.3171","volume":"32","author":[{"given":"Jacob","family":"Jo","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville;"},{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen L.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville;"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler M.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville;"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Garrett M.","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia L.","family":"Prosak","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amad","family":"Amedy","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trevor J.","family":"Anesi","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas P.","family":"Terry","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville;"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott L.","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville;"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Clin Spine Surg","first-page":"191","article-title":"Sports-related concussion in children and adolescents","volume":"30","author":"Refakis CA","year":"2017","unstructured":"Refakis CA, Turner CD, Cahill PJ. 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