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Avoiding video screens for 48 hours after a head injury decreases concussion recovery time
Clinical Question
Does avoiding screen time after an acute head injury decrease concussion recovery time?
Bottom line
In this study, avoiding video screens modestly increased the proportion of persons with concussion who recover and shortened the duration of symptoms. 2b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Unknown/not stated
Setting: Emergency department
Synopsis
These investigators recruited 125 persons, aged 12 to 25 years, who presented to an emergency department at a tertiary care center within 24 hours of an acute concussion. The participants had a Glasgow Coma Score of at least 15 and no intracranial abnormalities on imaging. They were randomized into 2 groups and asked to avoid the use of video screens for 48 hours (intervention; n = 59) or not to avoid video screens (control; n = 66). All participants completed the Post-Concussive Symptom Scale (PCSS) daily for the 10 days after enrollment. Although the PCSS is a validated research scale, it is not widely used in sports medicine clinics. It includes 22 items, each rated from 0 to 6 points (range = 0 - 132). A higher score indicates more severe symptoms. The main outcome of the study was time to recovery, defined by a PCSS score of 3 or less. Overall, 30 participants (a troubling 24%) did not complete the study; the dropout rate was the same in each group. The authors don’t report the number of participants who recovered, but information buried in a graph indicates that 21 of the 53 (60.4%) persons in the control group who had complete data recovered compared with 14 of 50 (72.0%) persons in the intervention group (hazard ratio [HR] 0.51; 95% CI 0.29 - 0.90). The women in the intervention group were less likely to recover than the men in the intervention group (HR 0.34; 0.19 - 0.60). Finally, among those who recovered, persons in the control group took longer to recover than persons in the intervention group (8.0 vs 3.5 days, respectively).
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
A pertinent, well-written study
This is an interesting study that has a direct influence on my day-to-day practice. Many thanks.
Screen time and concussion recovery
The finding are potentially important but I consider them preliminary for three reasons. #1 24% drop out rate #2 Although the patients were described as being "randomized" a review of the JAMA abstract indicates that this was initially a "convenience" sample. Therefore not true randomization. #3 Small sample size. Would love to see a larger proper randomized trial. One remaining issue is that patients can't be blinded to the intervention they receive. Perhaps there could be an embedded series of questions added that are not related to concussion recovery which when analyzed separately result in a score that is no different between the intervention and control group. It would be treat if this article in onto something here but I need more convincing before make a recommendation to patients about avoiding video for 48 hrs post-concussion.
What about screen time and long duration of concussion symptoms?
Concussion recovery times of less than a week are common. The problematic cases are where the patient continues to have symptoms for many months after the initial injury. I wonder what possible recovery mechanism could be affected by 'screen time'?
Concussion recovery and screen time
Useless
Study
Interesting but small numbers and high drop out rate.
screen free post concussion
good to know
avoid screen time for 48 hrs post concussion
shorter recovery time
study issues
the rate of drop out in this study really affects the ability to evaluate the data presented