• James D Carson, Dion Diep, Carmen Baker, Sari A Kraft, Nariko Kuwahara, Alisha Garel, and Pierre Frémont.
• Associate Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario. james.carson@utoronto.ca.
• Can Fam Physician. 2022 Mar 1; 68 (3): e87e91e87-e91.

ObjectiveTo determine whether the proportion of sport-related concussion (SRC) cases among student athletes that resulted in a relapse of their symptoms due to premature return to play (RTP) or premature return to learn (RTL) has changed compared with a prior (2006 to 2011) study.DesignRetrospective cohort study of electronic medical record charts from a 5-year period (2011 to 2016) compared with previous data.SettingA sport and exercise medicine physician's office-based practice in Ontario.ParticipantsTwo-hundred forty-one students who had 258 distinct cases of SRC diagnosed.Main Outcome MeasuresPremature RTP and RTL were defined as chart records documenting the relapse, recurrence, or worsening of concussion symptoms that accompanied the patient's RTP or RTL.ResultsBetween 2011 and 2016, premature RTP and RTL resulted in a relapse of symptoms in 26.7% and 42.6% of cases, respectively. When compared with data from the 2006 to 2011 chart review, the incidence of premature RTP decreased by 38.6%. However, the rate of the relapse of symptoms associated with premature RTL decreased by only 4.7%. There was a relapse of symptoms in 43.4% of the cases involving female students and 29.7% of the cases involving male students, indicating that female patients are more likely to experience a relapse of symptoms. Cases involving female athletes also resulted in much later RTP clearance compared with those involving male athletes, with a median duration that was almost double that of male athletes' cases (49 days vs 25 days).ConclusionAn important decrease in the relapse of symptoms in the context of premature RTP occurred over the 2006 to 2016 period. However, this decrease was minimal for RTL. This may reflect the fact that efforts to implement structured RTP strategies arose earlier than those to implement RTL strategies. Efforts are needed to find the best method of implementing a coordinated plan for the postconcussion athlete who is returning to school.Copyright© 2022 the College of Family Physicians of Canada.

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