Authors: Alexander Petronio, BS; Joseph A. Petronio, MD; Robert Doss; John Bedingham, BS; Mary Koolmo (St Paul, MN)

Introduction: Children who have suffered a concussion tend to have a longer period of recovery compared to adults. This course of recovery can vary dramatically from patientto patient, and is dependent upon a multitude of biopsychosocial factors. In order to tease apart some of these factors, we aimedto characterize the recovery differences in pediatric concussion patients injured during the summer months (SUM) versus the school year (SCH), and whether the increased academic demands endemic to high school contribute to longer recovery intervals. Methods: Patients (age 6-18) were grouped on the basis of injuries occurring during the summer (n = 119) or school year (n = 397). Demographic, medical/psychiatric history, injury characteristics, and clinical recovery data were abstracted from medical records. The groups were further categorized by school-level: elementary (EL), middle school (MS), and high school (HS). Recovery time was defined as the number of days between injury and final clinic visit. Parametric and non-parametric statistical procedures were utilized. Results: There were no statistically significant differences between the two groups with respect to demographics, medical/psychiatric histories, acute injury signs/symptoms, and most other clinical variables. The SCH group demonstrated a significantly longer recovery time (p < .05) and higher clinical utilization (p < 0.01) than the SUM group. This difference was greatest for high school-aged patients (p < .01). Conclusion: Children who sustained a concussion during the school year took significantly longer to recover than those injured during the summer when the academic demands and school environment are relatively minimal to non-existent. This effect was found to be greatest in high school-aged patients and occurred in the context of comparable demographics, acute injury characteristics, and medical/psychiatric histories. This finding highlights the need for parents, clinicians, and school officials to recognize and address factors that may influence recovery.