Effect of Cognitive and Physical Rest on Persistent Postconcussive Symptoms following a Pediatric Head Injury
Jeremy M Root1, Maegan D Sady2, Jiaxiang Gai3
1Division of Emergency Medicine, Children's National Health System, Washington, DC.
Insights
Resting after a pediatric concussion does not appear to reduce persistent symptoms. Early return to activity may be beneficial for children and adolescents recovering from concussion.
Area of Science:
- Pediatric neurology
- Sports medicine
- Concussion research
Background:
- Persistent postconcussive symptoms affect a significant portion of pediatric concussion patients.
- Current management guidelines for pediatric concussion are evolving.
Purpose of the Study:
- To evaluate the impact of cognitive and physical rest on persistent postconcussive symptoms in children and adolescents.
- To determine if increased rest correlates with a reduced incidence of prolonged concussion symptoms.
Main Methods:
- Prospective cohort study of 119 pediatric patients (ages 5-18) diagnosed with acute concussion.
- Participants were followed for one month, tracking days off from school and sports.
- Logistic regression analysis was used to examine associations with persistent postconcussive symptoms.
Main Results:
- 24% of participants experienced persistent postconcussive symptoms.
- Adolescent age was the only significant predictor of persistent symptoms in multivariable analysis.
- Moderate cognitive or physical rest did not decrease the odds of persistent postconcussive symptoms compared to minimal rest.
Conclusions:
- The study did not find that increased rest from school and sports reduced the odds of persistent postconcussive symptoms in pediatric concussion patients.
- Findings suggest that emerging evidence supporting early return to light activity may be a viable management approach.
Objective:
To evaluate the effect of cognitive and physical rest on persistent postconcussive symptoms in a pediatric population.
Study Design:
A prospective cohort study of 5- to 18-year-olds diagnosed with an acute concussion in a tertiary care pediatric emergency department was conducted from December 2016 to May 2019. Participants (n = 119) were followed over 1 month to track days off from school and sports and the development of persistent postconcussive symptoms (residual concussion symptoms beyond 1 month). Participants were dichotomized into minimal (≤2) and moderate (>2) rest, based on days off from school and sports after a concussion. Univariate and multivariable logistic regression analyses were completed to examine associations with persistent postconcussive symptoms.
Results:
Of the participants in our study, 24% had persistent postconcussive symptoms. Adolescent age, history of prolonged concussion recovery, and headache at presentation were associated with higher odds of persistent postconcussive symptoms in univariate analyses. In a multivariable logistic regression model, only adolescent age was associated with increased odds of persistent postconcussive symptoms. Compared with the minimal cognitive rest group, moderate cognitive rest did not decrease the odds of persistent postconcussive symptoms (aOR, 1.15; 95% CI, 0.44-2.99). Compared with the minimal physical rest group, moderate physical rest also did not decrease the odds of persistent postconcussive symptoms (aOR, 3.17; 95% CI, 0.35-28.78).
Conclusions:
Emerging evidence supports early return to light activity for recovery of acute pediatric concussion. Our study adds to this management approach as we did not find that rest from school and sports resulted in a decreased odds of persistent postconcussive symptoms.
