Concussion prolonged with unrestricted screen time

Abstract

Macnow T, Curran T, Tolliday C, Martin K, McCarthy M, Ayturk D, et al. Effect of Screen Time on Recovery from Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2021;175:1124-31.QuestionAmong adolescents and young adults with concussion, what is the clinical efficacy of unrestricted screen time, compared with screen-time abstinence, as measured by the Post-Concussive Symptom Scale (PCSS)?DesignSingle-center parallel-design randomized clinical trial.SettingUniversity of Massachusetts Medical Center in Worcester.ParticipantsChildren 12-25 years old, presenting to the ED within 24 hours of a head injury.InterventionScreen time permitted vs abstinence for 48 hours after injury.OutcomesDays to resolution of symptoms (resolution = PCSS score ≤ 3).Main ResultsMedian recovery time and screen-time minutes were longer in the screen-time permitted group compared with the abstinence group: 8.0 days and 630 minutes compared with 3.5 days and 130 minutes, P = .03 for recovery time, non-overlapping interquartile ranges for screen-time minutes, respectively.ConclusionsScreen–time abstinence improves concussion recovery time.CommentaryUsing a well-designed RCT, Macnow et al answered a common question from caregivers - should screen time be avoided after acute concussion. The evidence provided is compelling, not just because the difference in outcome was profound, but because the intervention is benign. Asking patients to minimize screen time for 48 hours, provides caregivers with actionable practical advice that is unlikely to cause significant harm. It is important to note that given the subjective nature of concussion symptoms and the inability to blind subjects, screen time restrictions may have had a placebo effect which encouraged reduced symptom reporting. Further research is necessary to replicate these findings, better understand the ideal duration of screen-time restriction, and the biopsychosocial mechanisms underpinning its benefit. However, until that research is completed, restricting screen time during the first 48 hours of injury should become the standard advice in the acute phase of concussion recovery. The pandemic has shown us that for children, screen time is not always discretionary. This study provides the evidence-based guidance that caregivers need to advocate for their children during acute concussion recovery. Macnow T, Curran T, Tolliday C, Martin K, McCarthy M, Ayturk D, et al. Effect of Screen Time on Recovery from Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2021;175:1124-31. QuestionAmong adolescents and young adults with concussion, what is the clinical efficacy of unrestricted screen time, compared with screen-time abstinence, as measured by the Post-Concussive Symptom Scale (PCSS)? Among adolescents and young adults with concussion, what is the clinical efficacy of unrestricted screen time, compared with screen-time abstinence, as measured by the Post-Concussive Symptom Scale (PCSS)? DesignSingle-center parallel-design randomized clinical trial. Single-center parallel-design randomized clinical trial. SettingUniversity of Massachusetts Medical Center in Worcester. University of Massachusetts Medical Center in Worcester. ParticipantsChildren 12-25 years old, presenting to the ED within 24 hours of a head injury. Children 12-25 years old, presenting to the ED within 24 hours of a head injury. InterventionScreen time permitted vs abstinence for 48 hours after injury. Screen time permitted vs abstinence for 48 hours after injury. OutcomesDays to resolution of symptoms (resolution = PCSS score ≤ 3). Days to resolution of symptoms (resolution = PCSS score ≤ 3). Main ResultsMedian recovery time and screen-time minutes were longer in the screen-time permitted group compared with the abstinence group: 8.0 days and 630 minutes compared with 3.5 days and 130 minutes, P = .03 for recovery time, non-overlapping interquartile ranges for screen-time minutes, respectively. Median recovery time and screen-time minutes were longer in the screen-time permitted group compared with the abstinence group: 8.0 days and 630 minutes compared with 3.5 days and 130 minutes, P = .03 for recovery time, non-overlapping interquartile ranges for screen-time minutes, respectively. ConclusionsScreen–time abstinence improves concussion recovery time. Screen–time abstinence improves concussion recovery time.