EFFECTS OF BRAIN INJURY ON COLLEGE ACADEMIC-PERFORMANCE

Brain injury, a leading cause of mortality, morbidity and disability i n the United States, has serious consequences and substantial costs. A lthough previous studies have assessed a variety of outcomes subsequen t to brain injury, documentation of performance prior to brain injury using a case-control approach has not been included; preinjury perform ance differences may confound the estimate of the effects of brain inj ury on performance. The primary objective of this study was to compare academic performance before and after brain injury in a population of university undergraduate students to determine the extent to which th e academic career of the brain-injured person was altered from what wo uld have been expected in the absence of such an injury. Cases include d all undergraduate students in a major university, between the ages o f 17 and 27, who incurred a brain injury requiring hospitalization bet ween 1980 and 1984 (n = 99). Two comparison groups were used to determ ine whether changes in academic performance were specifically related to brain injuries or injuries in general: (1) injured controls, i.e. 1 21 students between the ages of 17 and 27 years, hospitalized for inju ries other than to the central nervous system, and (2) uninjured acade mic controls, i.e. 198 students without injuries requiring hospitaliza tion during the study period, matched 2:1 to the brain-injured student s by age, gender, and completed course credits categorized as <90, gre ater than or equal to 90. Although there were no differences when the total groups, including both males and females, were compared, there w as a significant pre- to postinjury decrease in the grade point averag e for female cases when compared to their uninjured academic controls (p < 0.02). This difference was related to the effects of brain injury , and not to the effects of injury in general. No such difference was observed for the males. There were also no differences when the total groups, including males and females, were compared relevant to return to school. However, a significantly higher proportion of the female ca ses, compared with their uninjured academic controls, did not return t o school after their injury; similar findings were identified for the injured controls as well. Thus, these differences were not specific to brain injury but rather to injury in general. In spite of this observ ation, the difference be tween female cases who returned and those who did not return was associated with neurological deficits, especially upper left limb motor deficits, at the time of hospital discharge. The findings from this effort are suggestive of gender differences in the consequences of brain injury and serve as a basis for further studies to evaluate the magnitude of this problem.