Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial
Top Cited Papers
Open Access
- 1 February 2015
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 135 (2), 213-223
- https://doi.org/10.1542/peds.2014-0966
Abstract
OBJECTIVES: To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED). METHODS: Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1–2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory. RESULTS: Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P < .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P < .03) and slower symptom resolution. CONCLUSIONS: Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents’ symptom reporting was influenced by recommending strict rest.Keywords
This publication has 30 references indexed in Scilit:
- Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008Journal of Clinical Neuroscience, 2009
- Improving Identification and Diagnosis of Mild Traumatic Brain Injury With EvidenceJournal of Head Trauma Rehabilitation, 2008
- Concussion in Sports: Postconcussive Activity Levels, Symptoms, and Neurocognitive PerformanceJournal of Athletic Training, 2008
- Controversies in the evaluation and management of minor blunt head trauma in childrenCurrent Opinion in Pediatrics, 2007
- Experience-dependent behavioral plasticity is disturbed following traumatic injury to the immature brainBehavioural Brain Research, 2005
- Voluntary exercise following traumatic brain injury: brain-derived neurotrophic factor upregulation and recovery of functionNeuroscience, 2004
- Second impact syndrome: A rare, catastrophic, preventable complication of concussion in young athletesJournal of Emergency Nursing, 2003
- Effects of Enriched Environment and Fluid Percussion Injury on Dendritic Arborization within the Cerebral Cortex of the Developing RatJournal of Neurotrauma, 2002
- A 7-day activity diary for assessment of daily energy expenditure validated by the doubly labelled water method in adolescentsEuropean Journal of Clinical Nutrition, 1997
- A method to assess energy expenditure in children and adultsThe American Journal of Clinical Nutrition, 1983