Adolescents sustaining sport-related concussion often experience difficulties with the return-to-learn (RTL) process. Whereas the initial symptom burden has predicted prolonged RTL, no studies have established a relationship between acute cognitive symptoms and RTL duration. The authors sought to evaluate the relationship between initial cognitive symptoms and RTL duration.

A retrospective single-institution cohort study of adolescent athletes aged 12–23 years who were evaluated within 5 days of a diagnosed sport-related concussion between November 2017 and October 2020 was conducted. Athletes missing cognitive symptom ratings and RTL data were excluded. The primary exposure variable was the Cognitive Symptom Ratio (CSR), defined as total cognitive symptom cluster score divided by total Post-Concussion Symptom Scale (PCSS) score from the initial clinic visit. Primary and secondary outcomes were time to RTL and total length of care, respectively. Multivariable Cox proportional hazards modeling was used to assess the effect of CSR on RTL duration.

Of 653 athletes evaluated within 5 days of injury, 346 patients were included in the final cohort. Athletes reported a median initial PCSS score of 21 (interquartile range [IQR] 6–37) and a median cognitive symptom score of 4 (IQR 0–9). Most patients endorsed some degree of difficulty concentrating (n = 212, 61.3%). The median CSR was 0.18 (IQR 0.00–0.27). On multivariable regression analysis, a higher CSR was associated with prolonged RTL duration (HR 0.30, 95% CI 0.13–0.69, p = 0.004). When initial PCSS score was added to the model, the previously significant association between CSR and RTL was no longer significant (HR 0.67, 95% CI 0.29–1.59, p = 0.367). When dichotomized based on frequency distribution, a higher proportion of patients with low CSR achieved RTL by 7 days postinjury (82.2% vs 69.9%, p = 0.007), a difference not seen at 14 days (92.2% vs 87.3%, p = 0.133).

An acute ratio of cognitive symptoms may predict patients at increased risk for prolonged RTL and those with normal PCSS scores who may experience difficulties once resuming school activities.

遭受运动相关脑震荡的青少年在重返学习 (RTL) 过程中经常会遇到困难。虽然最初的症状负担预示着劳动时间延长，但没有研究确定急性认知症状与劳动时间之间的关系。作者试图评估初始认知症状与劳教持续时间之间的关系。

对 2017 年 11 月至 2020 年 10 月之间诊断出运动相关脑震荡后 5 天内对 12-23 岁青少年运动员进行了一项回顾性单机构队列研究。缺少认知症状评级和 RTL 数据的运动员被排除在外。主要暴露变量是认知症状比率（CSR），定义为总认知症状聚类评分除以初次就诊的脑震荡后症状量表（PCSS）总评分。主要和次要结局分别是劳教时间和总护理时间。使用多变量 Cox 比例风险模型来评估企业社会责任对劳教持续时间的影响。

在受伤后 5 天内接受评估的 653 名运动员中，有 346 名患者被纳入最终队列。运动员报告的中位初始 PCSS 评分为 21（四分位数范围 [IQR] 6-37），中位认知症状评分为 4（IQR 0-9）。大多数患者表示注意力有一定程度的困难（n = 212，61.3%）。 CSR 中位数为 0.18 (IQR 0.00–0.27)。在多变量回归分析中，较高的 CSR 与较长的 RTL 持续时间相关（HR 0.30，95% CI 0.13–0.69，p = 0.004）。当初始 PCSS 评分添加到模型中时，CSR 和 RTL 之间先前的显着关联不再显着（HR 0.67，95% CI 0.29–1.59，p = 0.367）。根据频率分布进行二分时，CSR 较低的患者在受伤后 7 天时达到 RTL 的比例较高（82.2% vs 69.9%，p = 0.007），而在 14 天时未见差异（92.2% vs 87.3%，p = 0.133） ）。

认知症状的严重比例可能预示着患者长期劳教的风险增加，而那些 PCSS 分数正常的患者一旦恢复学校活动可能会遇到困难。