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Background: Post-concussion sequelae in adolescents include physical, cognitive, and psychosocial effects that may result in reduced quality of life (QOL) and academic challenges when returning to school. The COVID-19 pandemic resulted in altered teaching and learning models outside the traditional in-person classroom, and elevated psychosocial stress and isolation among adolescents. It is unknown whether these changes affected QOL or academic challenges post-concussion. Hypothesis/Purpose: To compare self-reported QOL and academic challenges among concussed adolescents prior to and during the COVID-19 pandemic. Methods: Concussed adolescents were enrolled from secondary schools and children's medical centers across seven sites into the Sport Concussion Outcomes in Pediatrics (SCOPE) study (PRiSM Concussion RIG). Participants completed demographics, medical history, symptom report, the Concussion Learning Assessment and School Survey (CLASS) and QOL via PROMIS Pediatric Global 25 during their first evaluation visit. Participants were grouped by date ranges: September 2018-January 2020 (Pre-COVID-19) and September 2020-May 2021 (COVID-19). No participants were enrolled between February-August 2020 (cessation of clinical research activities during this time.). Results: A total of 141 patients were enrolled. Mean age=14.9±2.4 years, 61% self-reported as male, 82% white and 85% not Hispanic or Latino, 5.2 + 3.1 days post-injury (range=1-14 days). Seventy-four patients were enrolled prior to COVID, and 67 were enrolled during COVID (Table 1). No significant differences were found between the 'Pre-COVID-19' group versus 'During COVID-19' group in symptom resolution, symptom severity score, QOL, or academic concerns (Table 2). The only difference was the 'person at school who is best to coordinate support.' A significantly lower proportion of participants who sustained their concussion during COVID-19 reported their principal/assistant principal would be the best person to coordinate support compared to those who sustained their concussion before the COVID-19 pandemic. In contrast, a significantly higher proportion of those who sustained their concussion during the COVID-19 pandemic reported their coach would be the best person to coordinate support. Conclusion: In this convenience yet nationally representative sample, students who sustained a concussion during the pandemic did not report increased academic concerns or reduced QOL compared to those whose injury was prior to the pandemic. Median symptom severity was lower during the pandemic, though not statistically significant. These findings could represent shifted priorities of the principal/assistant principal but still adequate support from medical and school-based staff; less academic stress and greater flexibility during the COVID-19 pandemic; or may represent limitations in the CLASS instrument to detect differences that occurred during the pandemic. Table 1 Participant characteristics by group. Data are presented as mean (standard deviation) or n (% within group). Table 2 Clinical and Quality of Life characteristics (via PROMIS Pediatric Global 25) between groups, assessed at the initial post-concussion assessment. Data are presented as median [interquartile range] and compared using Mann Whitney U tests. [ABSTRACT FROM AUTHOR]

Background: Concussion produces diverse symptoms, functional impairment, and societal limitations that may result in decreased quality of life (QoL). Various factors, including sex, prior concussion and mental health history have been associated with a reduction of QoL compared to baseline. However, the influence of various factors on post-concussion QoL has not been investigated in a prospective, multi-site investigation. Hypothesis/Purpose: To examine factors that may predict decreased post-concussion QoL and increased symptom severity. Methods: Pediatric patients (6-18 years) were enrolled as part of the Sport Concussion Outcomes in Pediatrics (SCOPE) study at 6 children's medical centers and 9 secondary schools during the initial visit for a diagnosis of sport-related concussion. Patients completed a medical history, the Post-Concussion Symptom Inventory (PCSI), and Patient-Reported Outcomes Measurement Information System Pediatric Profile-25 (PROMIS-PP). The PCSI is an age-specific, validated symptom survey on which patients rate their current concussion symptoms. Higher numbers indicate greater symptom severity. The PROMIS-PP includes six domains: physical functioning and mobility, anxiety, depressive symptoms, fatigue, peer relationships, and pain interference. Lower scores indicate higher QoL for all domains, except peer relationships, where a higher score indicates better QoL. Eight predictor variables (Table 1) were assessed using negative binomial regression models constructed for each dependent variable. Results: The analysis included 141 patients (14.9±2.4 years, 40.4% female). Patients were enrolled 5.2±3.1 days post-concussion (range=1-14 days). The percentage (frequency) of patients with a positive self-reported medical history included prior concussion (38%, n=55), migraines (4% (n=5), ADD/ADHD (11%, n=55), LOC at time of injury (7%, n=10), and amnesia at time of injury (20%, n=29). Table 1 presents the pre-injury characteristics associated with each QoL domain and the total PCSI score. Self-reported amnesia was a significant predictor of lower QoL for the anxiety, depressive symptoms, fatigue, and pain interference domains. Migraines were associated with higher QoL scores in the anxiety domain. Younger age and longer time since injury were associated with higher symptom severity. Conclusion: Self-reported amnesia at the time of concussion was associated with a lower QoL related to anxiety, depressive symptoms, fatigue, and pain interference. Interestingly prior concussion and other pre-injury factors did not significantly impact post-injury QoL at the initial visit. Future studies should assess the influence of these factors on QoL at later post-injury time points using a concussion-specific outcomes instrument. Patients may be able to better reflect on the impact of the concussion on QoL over time during recovery. Table 1. Patient characteristics associated with each quality-of-life domain and total PCSI score. Due to the zero-inflated count variable nature of the PROMIS variables, negative binomial regression models were constructed for each domain. *Significant predictor of QoL domain. [ABSTRACT FROM AUTHOR]

Background: Concussion may cause physical and cognitive deficits that can affect the ability of students to perform at their typical academic level in school. Symptomatic students and their parents have previously reported concern about the impact of concussion on school performance. However, student confidence in their school's ability to support return to school and its relationship with recovery time and overall academic concern has not been investigated. Hypothesis/Purpose: To determine if student confidence in their school's ability to support return to school following concussion is associated with recovery time and other academic concerns. Methods: Student-athletes were enrolled in the Sport Concussion Outcomes in Pediatrics (SCOPE) study by a physician or athletic trainer across seven sites. Students and their parent/guardian completed the Concussion Learning Assessment and School Survey (CLASS) along with other standardized assessments. Participants were grouped based on responses to the CLASS question about confidence in their school's ability to support return to school (very confident vs. not/mildly/moderately confident). Symptom resolution time, initial symptom severity, academic outcomes and parent-reported expected academic supports were evaluated using separate Chi-squared analyses. Results: A total of 141 patients were included; 72 (51%) reported being very confident in their school's ability to support return to school. There was no significant difference in time to symptom resolution between groups (p = 0.84; mean difference= 0.9 days [95% CI= -7.4, 9.2]). The group who was very confident in school support reported a significantly lower initial symptom severity (p <0.001; mean difference= 0.12 [95% CI= 0.05, 0.18]). A higher proportion of those who felt very confident in school support reported no concern about concussion affecting school learning and performance (Table 2; 36% vs 10%, p=0.005). A lower proportion of those who felt very confident in their school support felt the concussion might affect their grades compared to those who expressed no/mild/moderate confidence in school support (Table 2; 56% vs 23%, p=0.001). Conclusion: In this multi-center study, although there was no difference in symptom resolution between groups, students who reported being very confident in their schools' ability to support return to school had a lower initial symptom severity, expressed less concern about the concussion affecting their school learning, performance, and grades. These findings support recommendations for a collaborative team to assist students returning to school following concussion. Table 1. Patient characteristics for the two participant groups. Data are presented as mean (sd) or number within group (% within group). Table 2. Academic outcomes for both participant groups. [ABSTRACT FROM AUTHOR]

Background: Persistent postconcussive symptoms (PPCS) can negatively impact quality of life, school, and return to sport. The Predicting and Preventing Postconcussive Problems in Pediatrics [5P] clinical risk score has been validated in the Emergency Department setting to predict pediatric patients at risk of PPCS using 9 variables. Hypothesis/Purpose: To determine if the 5P risk score, obtained within 14 days of concussion, predicts which athletes seen in an athletic training or pediatric sports medicine clinic setting develop PPCS in a multi-center sample. Methods: Data were prospectively collected from participants enrolled in the Sport Concussion Outcomes in Pediatrics (SCOPE) study between September 2018-May 2021 across seven sites. Participants aged 6-18 years diagnosed with a concussion who presented within 14 days of injury were included. Demographics, medical history, and the Postconcussion Symptom Inventory (PCSI) were reviewed to calculate the 5P risk score. 5P risk scores were stratified as low (0-3 points), medium (4-8 points), and high risk (9-12 points). Participants were grouped based on symptom resolution time: PPCS (≥28 days) and no PPCS (<28 days). We compared total symptom resolution time among the 5P risk categories using one-way ANOVA and assessed the odds of developing PPCS based on 5P risk score using a binary logistic regression model. Results: We included 117 participants: 23 with PPCS (19.7%). A higher proportion of the PPCS group were female, were seen in a sports medicine clinic setting, and had a longer time to initial presentation (Table 1). Both PCSI symptom severity and 5P risk score were significantly higher in the PPCS group compared to the no PPCS group (p<0.001). Participants with high risk 5P scores had a significantly longer mean symptom resolution time compared to those with low risk scores (Figure 1; 28.4±18.2 vs 7.1±6.8 days, p=0.009). After adjusting for potential confounding variables of initial symptom severity, time to presentation, and assessment setting, each point increase on the 5P risk score was associated with a 1.7x odds of developing PPCS (odds ratio=1.66; 95% CI=1.13, 2.41; p=0.009). Conclusion: In a multi-center sample of youth athletes, the 5P risk score accurately predicted which athletes were at risk for developing PPCS. The odds of developing PPCS increases with each point increase on the risk score. The 5P risk score can help clinicians identify which athletes are likely to develop PPCS, which may aid in educating families on expectations of recovery and/or provide opportunities for targeted intervention to facilitate sooner recovery. Table 1. 5 P Variables and other Patient Characteristics Comparing PPCS and no PPCS groups Figure 1. Symptom resolution time among the three 5P risk categories (Low : n=15; Medium : n=80; High : n=25; p=0.009) [ABSTRACT FROM AUTHOR]