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Objective: This study sought to (1) collate the experiences of university students with concussion history and academic stakeholders through interviews and (2) develop concussion management recommendations for institutions of higher learning using a multidisciplinary Delphi procedure. Setting: Remote semistructured interviews and online surveys. Participants: The first aim of this study included undergraduate university students with concussion history who did not participate in varsity athletics (n = 21; 57.1% female), as well as academic faculty/staff with experience assisting university students with their postconcussion academic needs (n = 7; 71.4% female). The second aim enrolled 22 participants (54.5% female) to serve on the Delphi panel including 9 clinicians, 8 researchers, and 5 academic faculty/staff. Design: An exploratory-sequential mixed-methods approach. Main Measures: Semistructured interviews were conducted to unveil barriers regarding the return-to-learn (RTL) process after concussion, with emergent themes serving as a general framework for the Delphi procedure. Panelists participated in 3 stages of a modified Delphi process beginning with a series of open-ended questions regarding postconcussion management in higher education. The second stage included anonymous ratings of the recommendations, followed by an opportunity to review and/or modify responses based on the group's consensus. Results: The results from the semistructured interviews indicated students felt supported by their instructors; however, academic faculty/staff lacked information on appropriate academic supports and/or pathways to facilitate the RTL process. Of the original 67 statements, 39 achieved consensus (58.2%) upon cessation of the Delphi procedure across 3 main categories: recommendations for discharge documentation (21 statements), guidelines to facilitate a multidisciplinary RTL approach (10 statements), and processes to obtain academic supports for students who require them after concussion (8 statements). Conclusions: These findings serve as a basis for future policy in higher education to standardize RTL processes for students who may need academic supports following concussion. [ABSTRACT FROM AUTHOR]

Objective: Prior psychometric research has identified symptom subscales for the Post-Concussion Symptom Scale (PCSS) based on confirmatory factor analysis (CFA), including cognitive, physical, sleep-arousal, and affective symptom factors. Study objectives included: (1) replicate the 4-factor PCSS model in a diverse sample of athletes with concussion, (2) test the model for invariance across race, gender, and competitive level, and (3) compare symptom subscale and total symptom scores across concussed groups with established invariance. Setting: Three regional concussion care centers. Participants: A total of 400 athletes who completed the PCSS within 21 days of concussion (64% boys/men, 35% Black, and 69.5% collegiate athletes). Design: Cross-sectional. Main Measures: A CFA tested the 4-factor model and measurement invariance testing was performed across racial, competitive level, and gender groups. Symptom subscales and total symptom severity scores were compared based on demographic groupings with established invariance. Results: The 4-factor model fit well and strong invariance was established across all demographic categories, indicating symptom subscales could be meaningfully compared across groups. Black and White athletes differed on total symptoms (U = 15 714.5, P =.021, r = 0.12), sleep-arousal symptoms (U = 15 953.5, P =.026, r = 0.11), and physical symptoms (U = 16 140, P =.051, r = 0.10), with Black athletes reporting slightly more symptoms. Collegiate athletes reported greater total symptom severity (U = 10 748.5, P <.001, r = 0.30), with greater symptom reporting on the cognitive (U = 12 985, P <.001, r = 0.21), sleep-arousal (U = 12 594, P <.001, r = 0.22), physical (U = 10 959, P <.001, r = 0.29), and emotional (U = 14 727.5, P =.005, r = 0.14) symptom subscales. There were no significant differences by gender in the total symptom score or subscale scores. After controlling for time since injury, no racial differences persisted, but a significant difference by competitive level in physical symptom reporting (F = 7.39, P =.00, η2 = 0.02) and total symptom reporting (F = 9.16, P =.003, η2 = 0.02) remained. Conclusion: These results provide external validation for the PCSS 4-factor model and demonstrate that symptom subscale measurements are comparable across race, genders, and competitive levels. These findings support the continued use of the PCSS and 4-factor model for assessing a diverse population of concussed athletes. [ABSTRACT FROM AUTHOR]