#VisualAbstract: Avoiding screen time after concussion may shorten recovery time

1. In a small randomized controlled trial of patients aged 12-25 with concussion, recovery time was significantly shorter in patients asked to abstain from screen time for 48 hours after injury.

2. Patients asked to abstain from electronics reported significantly less screen time than those who were not, but still used screens for more than 2 hours per day on average.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Concussion, also known as mild traumatic brain injury, is common in children and adolescents. The current standard of care includes a period of physical and cognitive rest in the 24 to 48 hours following the initial injury. However, there is a lack of consensus on whether use of electronics is one of the activities which patients should avoid. This single-center trial randomized 125 patients to either a screen time permitted group or a screen time abstinent group. Patients who abstained from screen time for 48 hours after injury had a median recovery time of 3.5 days compared to 8 days for those who were not asked to abstain. On surveys completed during the first 3 days after initial emergency department visit, patients asked to abstain from screen time reported a median 130 minutes of screen time compared to 630 minutes for the screen time permitted group, indicating adherence to the study instructions. This study’s limitations include its small sample size and self-reporting of screen time, which could be subject to reporting bias, particularly for patients who were asked to abstain from screens. Still, however, this study meets a distinct need for rigorous study of electronics use in the post-concussion period. It presents compelling evidence that pediatric and young adult concussion patients should be asked to avoid phone, television, and computer screens just as they are currently asked to avoid physical and mental exertion.

Click to read the study in JAMA Pediatrics

Click to read an accompanying editorial in JAMA Pediatrics

Relevant Reading: Predictors of clinical recovery from concussion: A systematic review

In-Depth [randomized controlled trial]: Study subjects were patients aged 12-25 presenting within 24 hours of head injury to the pediatric or adult emergency department at a single academic medical center in Massachusetts between 2018 and 2020. The primary outcome, number of days until resolution of concussion symptoms, was defined based on a score of 3 or lower on the post-concussive symptom scale (PCSS). Patients with a PCSS score of 3 or lower at the time of enrollment were excluded. Female patients were less likely than males to attain recovery during the study period. In an intention-to-treat analysis using a Cox regression model, patients in the screen time permitted group were less likely to recover during the study period (hazard ratio 0.51, 95% confidence interval 0.29-0.90). Wilcoxon rank sum test was used for analysis of median recovery time. A sensitivity analysis was also performed using higher and lower PCSS score cutoffs and found a persistent between-group difference in recovery times. About 24% of patients were lost to follow-up, though this proportion was similar between groups.

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