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What factors must be considered in ‘return to school’ following concussion and what strategies or accommodations should be followed? A systematic review
  1. Laura K Purcell1,
  2. Gavin A Davis2,
  3. Gerard A Gioia3
  1. 1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  2. 2 Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  3. 3 Division of Pediatric Neuropsychology, Children’s National Health System, Rockville, Maryland, USA
  1. Correspondence to Dr Laura K Purcell, Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; lpurcell1015{at}


Objective To evaluate the evidence regarding (1) factors affecting return to school (RTS) and (2) strategies/accommodations for RTS following a sport-related concussion (SRC) in children and adolescents.

Design A systematic review of original studies specifically addressing RTS following concussion in the paediatric and sporting context.

Data sources MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid) electronic databases and the grey literature OpenGrey, and Google Advanced.

Eligibility criteria Studies were included if they were original research on RTS following SRC in children aged 5–18 years published in English between 1985 and 2017.

Results A total of 180 articles were identified; 17 articles met inclusion criteria. Several factors should be considered for RTS after concussion, including: symptomatology; rest following injury; age/grade; and course load. On RTS after concussion, 17%–73% of students were provided academic accommodations or experienced difficulty with RTS. Students were more likely to obtain academic accommodations in schools with a concussion policy if they had a medical RTS letter and had regular medical follow-up after concussion.

Conclusions Schools should have a concussion policy and offer individualised academic accommodations to students recovering from SRC on RTS; a medical letter should be provided to facilitate provision/receipt of academic accommodations; students should have early, regular medical follow-up following SRC to help with RTS and monitor recovery; students may require temporary absence from school after SRC; clinicians should assess risk factors/modifiers that may prolong recovery and require more intensive academic accommodations.

PROSPERO registration number CRD42016039184.

  • concussion
  • children
  • adolescent
  • sport
  • school
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  • Contributors All authors contributed to the development of the search strategy. LKP and GAD ran the searches independently and reviewed the results, selected the papers and compiled the data extraction tables as well as the risk of bias assessment. GAG identified additional pertinent studies for inclusion in the systematic review not identified by the search strategy and provided a template of the RTS letter in Appendix A. All authors contributed to the writing and critical review of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests LKP and GAD received travel expenses for the Berlin Concussion Conference in October 2016.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at This study was presented in part at the 5th International Consensus Conference on Concussion in Sport in Berlin 2016, and some of these results were published with the conference proceedings.

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