When kids are ready to resume classes after being out for a concussion, schools' preparedness to handle them can vary widely, a new study suggests.
The study, conducted in Ohio, found variations in high school principals' resources and management strategies for students returning to school after a concussion.
"We have a lot of guidelines for returning to (sports after a concussion), but we have no guidelines for returning to school," Dr. Geoffrey Heyer, who led the study, told Reuters Health.
"Returning to school is more important than returning to sports," he added.
Concussion symptoms can include memory problems, headaches, irritability or sleeping more than usual. Studies have shown that returning to sports before symptoms have gone away can lengthen recovery time.
With growing awareness about the dangers of getting back on the field after concussions, all 50 states have enacted so-called return-to-play laws, which generally require medical clearance before student athletes with a concussion can get back on the field.
But students can and should return to school before they return to sports, Heyer noted.
"We want to get them into school," Heyer said. "But we also want to accommodate them. We can start with half days. Some accommodations are removing computer screens, having kids eat lunch in a quiet area."
"We don't encourage kids to be out of school for long periods of time," Dr. Mark Halstead, a surgeon at Washington University in St. Louis, Missouri, told Reuters Health. "They get very behind, and then they get anxious."
"They typically should not be out for more than a few days," said Halstead, who specializes in sports medicine.
Yet when they first come to see him, many of his patients have been out of school for a month or more, said Heyer, who is a pediatric neurologist at Nationwide Children's Hospital in Columbus, Ohio.
Heyer and his team sent surveys to 695 public high school principals in Ohio in 2013 and 2014, to determine their knowledge, resources and policies related to monitoring and accommodating students returning to school after concussions.
As reported in the Journal of Pediatrics, the researchers received completed surveys from 465 principals, or 67 percent, representing 85 of the state's 88 counties.
Less than half had taken a concussion-management training course.
About a third said their schools provided families with written concussion plans, but less than a quarter of the plans addressed potential academic adjustments and accommodations, the study found.
Most principals were willing to provide students with short-term academic accommodations. And four out of five schools did have designated 'case managers' responsible for monitoring the academic progress of students recovering from concussion. Half the time, the case manager was an athletic trainer.
But when principals were asked if they could identify someone at their school who communicates with students' health care providers after a concussion, nearly 86 percent could do so when the injured child was a student-athlete, compared to only about 79 percent when the student hadn't been injured in a school sports activity.
Preparedness plans shouldn't concentrate only on school athletes, the researchers suggest. They point out that in an earlier U.S. study, only 46 percent of emergency department visits for concussion among high school-aged patients were sports-related, and less than half of those sports-related concussions were related to organized team sports.
The results of the survey underscore the need for guidelines governing students' return to academics, Heyer said.
"Although return-to-play guidelines for the student-athlete have received considerable attention, few data exist to determine best practices for the student with concussion returning to school," he and his colleagues conclude.
"As of February 2014," they add, "all 50 states have passed laws that address concussion education and practices in youth sports. In contrast, the implementation of educational protocols that optimize student learning and return to school after concussion are only beginning to gain momentum."
U.S. emergency rooms treat more than 170,000 traumatic brain injuries related to sports and recreation among children and teenagers each year, according to the Centers for Disease Control and Prevention (CDC).
Between 2001 and 2009, emergency room visits for concussions and other brain injuries among children and adolescents rose 60 percent, the CDC says.
A study released in April found that concussions among high school athletes became more common with every passing year between 2005 and 2012 (see Reuters Health story of May 7, 2014 here: reut.rs/QGpQIl).
Other studies have also shown spikes in high school concussions, although it's not clear whether the numbers reflect a real increase or an uptick in the count resulting from growing awareness.