School nurses are often looked to coordinate care for students with a concussions. School-based concussion return-to-school policies may help provide guidance to help school nurses navigate this process. Using data from the 2024 School Pulse Panel (a nationally representative sample of U.S. public school principals), the purpose of this study was to assess the prevalence of school-based concussion policies and their components (e.g., staff training, accommodations for students). Results from 1,683 respondents showed that most principals (75%) reported that their school had a concussion policy during the 2023–2024 school year. Of those with a concussion policy, 58% reported that their concussion policy included information on how to support students in the classroom and 29% responded that their concussion policy required training for staff on concussion. Dedicated efforts to promote comprehensive policies and standardization of best practices may be beneficial to promote uptake and limit inconsistencies in concussion management plans and practices.
BakerJ. G.LeddyJ. J.DarlingS. R.RiegerB. P.MashtareT. L.SharmaT.WillerB. S. (2015). Factors associated with problems for adolescents returning to the classroom after sport-related concussion. Clinical Pediatrics, 54(10), 961–968. https://doi.org/10.1177/0009922815588820
2.
Centers for Disease Control and Prevention. (2015). Report to congress on traumatic brain injury in the United States: Epidemiology and rehabilitation. U.S. Department of Health and Human Services.
3.
Centers for Disease Control and Prevention. (2018). Report to congress: The management of traumatic brain injury in children. U.S. Department of Health and Human Services.
4.
Centers for Disease Control and Prevention. (2025). Get your school prepared to manage traumatic brain injuries (TBI) and concussions: Example TBI management plan for schools and school districts. U.S. Department of Health and Human Services.
5.
ChangD.SarmientoK.WaltzmanD. (2025). Improvements in school professionals’ knowledge and self-efficacy after completing CDC HEADS UP to schools online training. Journal of School Nursing, 95(7), 510–521. https://doi.org/10.1111/josh.70022
6.
CookN. E.GaudetC. E.Kissinger-KnoxA.LiuB. C.HunterA. A.NormanM. A.SaadiA.IversonG. L. (2023). Race, ethnicity, and clinical outcome following sport-related concussion: A systematic review. Frontiers in Neurology, 14, Article 1110539. https://doi.org/10.3389/fneur.2023.1110539
7.
CoxeK.HamiltonK.HarveyH. H.XiangJ.RamirezM. R.YangJ. (2018). Consistency and variation in school-level youth sports traumatic brain injury policy content. Journal of Adolescent Health, 62(3), 255–264. https://doi.org/10.1016/j.jadohealth.2017.07.003
8.
CoxeK. A.SullivanL.NewtonA.YangJ. (2020). Barriers to the implementation of state concussion laws within high schools. Journal of Adolescent Health, 66(2), 233–239. https://doi.org/10.1016/j.jadohealth.2019.08.016
9.
DaughertyJ.YuanK.SarmientoK.LawR. (2024). Are there seasonal patterns for emergency department visits for head injuries in the USA? Findings from the National Electronic Injury Surveillance System-All Injury Program. Injury Prevention, 30(1), 46–52. https://doi.org/10.1136/ip-2023-044971
10.
DeMatteoC. A.JakubowskiJ.RandallS.StazykK.LinC.-Y.YakubovR. (2022). School performance in youth after a concussion. Frontiers in Sports and Active Living, 4, Article 1008551. https://doi.org/10.3389/fspor.2022.1008551
11.
DePadillaL.MillerG. F.Everett JonesS. E. (2020). Characteristics of schools with youth sports concussion-related educational policies and practices. The Journal of School Health, 90(7), 520–526. https://doi.org/10.1111/josh.12900
12.
DePadillaL.MillerG. F.JonesS. E.PetersonA. B.BreidingM. J. (2018). Self-reported concussions from playing a sport or being physically active among high school students—United States, 2017. Morbidity and Mortality Weekly Report, 67(24), 682–685. https://doi.org/10.15585/mmwr.mm6724a3
GonzalezL.JonesL. E.FakehM.ShahN.PanchellaJ. A.ShendellD. G. (2020). Incidence reporting via online high school concussion surveillance by certified athletic trainers and school nurses, 2015–2018. Injury Epidemiology, 7(1), Article 1. https://doi.org/10.1186/s40621-019-0228-5
15.
HalsteadM. E.WalterK. D., The Council on Sports Medicine and Fitness. (2018). Sport-related concussion in children and adolescents. Pediatrics, 142(6), Article e20183074. https://doi.org/10.1542/peds.2018-3074
16.
HessC. W.CampbellJ. K.HackmanH.HaydenL.HowlandJ. (2025). Concussion management policy implementation in high schools: Examining policy through a disproportionality lens. Journal of Law, Medicine & Ethics, 53(2), 281–288. https://doi.org/10.1017/jme.2025.10112
17.
LaraM.RosenbaumS.RachelefskyG.NicholasW.MortonS. C.EmontS.BranchM.GenoveseB.VaianaM. E.SmithV.WheelerL.Platts-MillsT.ClarkN.LurieN.WeissK. B. (2002). Improving childhood asthma outcomes in the United States: A blueprint for policy action. Pediatrics, 109(5), 919–930. https://doi.org/10.1542/peds.109.5.919
18.
Lumba-BrownA.YeatesK. O.SarmientoK.BreidingM. J.HaegerichT. M.GioiaG. A.TurnerM.BenzelE. C.SuskauerS. J.GizaC. C.JosephM.BroomandC.WeissmanB.GordonW.WrightD. W.MoserR. S.McAvoyK.Ewing-CobbsL.DuhaimeA.-C.TimmonsS. D. (2018). Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatrics, 172(11), Article e182853. https://doi.org/10.1001/jamapediatrics.2018.2853
19.
MillerG. F.DePadillaL.JonesS. E.LionbargerM.ThigpenS. (2022a). Prevalence of concussion-related policies and practices among public school districts in the United States, 2012 and 2016. Journal of Public Health Management and Practice, 28(1), E194–E197. https://doi.org/10.1097/PHH.0000000000001239
20.
MillerG. F.SarmientoK.Haarbauer-KrupaJ.JonesS. E. (2022b). The association between school district-based policies related to concussions and concussions among high school students. Journal of School Nursing, 92(2), 140–147. https://doi.org/10.1111/josh.13113
21.
National Academies of Sciences, Engineering, and Medicine. (2022). Traumatic brain injury: A roadmap for accelerating progress. The National Academies Press.
22.
National Association of School Nurses. (2021). Concussions: School-based management [Position statement].
OlympiaR. P.RitterJ. T.BradyJ.BramleyH. (2016). Return to learning after a concussion and compliance with recommendations for cognitive rest. Clinical Journal of Sport Medicine, 26(2), 115–119. https://doi.org/10.1097/JSM.0000000000000208
26.
PietzK.GravesJ.WeybrightE.PinkletonB.KleinT. (2021). Concussions at school: The experiences and knowledge of school nurses. American Journal of Nursing, 121(2), 28–38. https://doi.org/10.1097/01.NAJ.0000733428.67589.5e
27.
PopoliD. M.BurnsT. G.MeehanW. P.ReisnerA., Children’s Healthcare of Atlanta. (2014). CHOA Concussion consensus: Establishing a uniform policy for academic accommodations. Clinical Pediatrics, 53(3), 217–224. https://doi.org/10.1177/0009922813499070
28.
PurcellL. K.DavisG. A.GioiaG. A. (2019). What factors must be considered in “return to school” following concussion and what strategies or accommodations should be followed? A systematic review. British Journal of Sports Medicine, 53(4), 250. https://doi.org/10.1136/bjsports-2017-097853
29.
RansomD. M.VaughanC. G.PratsonL.SadyM. D.McGillC. A.GioiaG. A. (2015). Academic effects of concussion in children and adolescents. Pediatrics, 135(6), 1043–1050. https://doi.org/10.1542/peds.2014-3434
30.
ReedN.ZemekR.DawsonJ.LedouxA.-A.ProvvidenzaC.PanicciaM.TatarynZ.YeatesK. (2024). Living guideline for pediatric concussion. https://www.pedsconcussion.com
31.
RussellK.SelciE.BlackB.CochraneK.EllisM. (2019). Academic outcomes following adolescent sport-related concussion or fracture injury: A prospective cohort study. PLoS ONE, 14(4), Article e0215900. https://doi.org/10.1371/journal.pone.0215900
32.
SilverbergN. D.IversonG. L.CoganA.Dams-O’ConnorK.DelmonicoR.GrafM. J. P.IaccarinoM. A.KajankovaM.KaminsJ.McCullochK. L.McKinneyG.NageleD.PanenkaW. J.RabinowitzA. R.ReedN.WetheJ. V.WhitehairV.ZemekR. (2023). The American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 104(8), 1343–1355. https://doi.org/10.1016/j.apmr.2023.03.036
33.
SteinC. J.MacDougallR.Quatman-YatesC. C.MyerG. D.SugimotoD.DennisonR. J.MeehanW. P. (2016). Young athletes’ concerns about sport-related concussion: The patient’s perspective. Clinical Journal of Sport Medicine, 26(5), 386–390. https://doi.org/10.1097/JSM.0000000000000268
34.
SullivanL.HarveyH. H.SmithG. A.YangJ. (2020). Putting policy into practice: School-level compliance with and implementation of state concussion laws. Journal of Public Health Management and Practice, 26(Suppl. 2), S84–S92. https://doi.org/10.1097/PHH.0000000000001128
35.
Takagi-StewartJ.QiuQ.MillsB.AveryA. D.MumaA.VavilalaM. S. (2022). Association of concussion with high school academic standing: Sex, school grade, and race as stratifiers. Injury Prevention, 28(5), 476–479. https://doi.org/10.1136/ip-2022-044568
36.
WaltzmanD.BlackL. I.DaughertyJ.PetersonA. B.ZablotskyB. (2025). Prevalence of traumatic brain injury among adults and children. Annals of Epidemiology, 103, 40–47. https://doi.org/10.1016/j.annepidem.2025.02.005
37.
WaltzmanD.DaughertyJ.SarmientoK.Haarbauer-KrupaJ.CampbellH.FerrellD. (2022). Prevalence of suspected concussions among K–12 students in Utah: Findings from Utah’s Student Injury Reporting system. Journal of School Health, 92(3), 241–251. https://doi.org/10.1111/josh.13126
38.
Welch BaconC. E.KayM. C.WeberM. L.TierneyD. K.Valovich McLeodT. C. (2018). School nurses’ perceived challenges with concussion management procedures in the secondary school setting. SAGE Open Nursing, 4, Article 2377960818798437. https://doi.org/10.1177/2377960818798437
39.
WicklundA.AndrewsB.CoatsworthJ. D. (2022). School concussion policy in Colorado: Lack of knowledge and access are barriers to education. Journal of School Nursing, 38(5), 442–448. https://doi.org/10.1177/1059840520964925
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