INDIANAPOLIS — In a new collaborative study conducted by Indiana University School of Medicine and Brain Injury Association of America (BIAA), researchers found that many of the nation’s K-12 schools do not have sufficient concussion protocols in place and do not adequately train staff for managing the recovery process following injury.
The study utilized public data and was published by the Journal of School Nursing.
Concussion, a form of traumatic brain injury, can cause symptoms that include headaches and trouble with concentration, memory, balance, mood and sleep. Returning students to class after a concussion is a delicate process that requires adequate support.
"School nurses are absolutely central to concussion management in schools, and in many cases, they're carrying a significant share of that responsibility," said Kelly Sarmiento, MPH, director of outreach programs for the Brain Injury Association of America and corresponding author of the study.
School nurses must often coordinate with families, healthcare providers and school staff while also monitoring student symptoms.
"Our findings show that many nurses may be doing this without the support they need," Sarmiento said. "About one in four schools reported having no concussion policy at all, and even among those that do, fewer than a third require staff training. That puts added pressure on school nurses to fill in the gaps, whether that’s educating colleagues, coordinating care, or ensuring students get the accommodations they need to recover and succeed."
Dana Waltzman, PhD, associate research professor of physical medicine and rehabilitation at IU School of Medicine and co-author of the study, said the reasons for these policy holes are varied and complex. This study did not seek to find a root cause, but past research in the area points to likely causes.
"Previous research suggests several possible factors, including limited staffing and resources, lack of access to school health professionals such as full-time nurses or athletic trainers, competing priorities and challenges implementing policies consistently across schools," Waltzman said.
"We also found that schools in higher-poverty communities, schools with larger proportions of non-white students and smaller schools were less likely to report having concussion policies, which may point to resource and capacity differences."
The study utilized data from the School Pulse Panel, an annual survey filled out by school principals and collected by the National Center for Education Statistics. It was conducted without financial support.
Research shows that students recover best when they gradually return to school and receive the classroom support they need based on their symptoms. Following evidence-based guidance helps support recovery while minimizing disruptions to learning.
The Brain Injury Association of America recommends schools adopt standardized, evidence-based practices in handling concussions. There should also be a clear delineation of who is responsible for coordinating a student’s care, including setting a return timetable for classroom instruction.
Anyone interested in learning more should contact the National Brain Injury Information Center at 1-800-444-6443 or braininjuryinfo@biausa.org to speak to a specialist about help with care needs, legal and financial resources and community services.
About the Indiana University School of Medicine
The IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability. According to the Blue Ridge Institute for Medical Research, the IU School of Medicine ranks No. 15 in 2025 National Institutes of Health funding among all public medical schools in the country.
For more news, visit the IU School of Medicine Newsroom: medicine.iu.edu/news
About the Brain Injury Association of America
The Brain Injury Association of America is the country’s oldest and largest nationwide brain injury advocacy organization. Our mission is to advance awareness, research, treatment, and education, and to improve the quality of life for all people affected by brain injury. We are dedicated to increasing access to quality health care and raising awareness and understanding of brain injury.