Strict rest after concussion did not improve outcomes

Strict rest immediately after a concussion did not improve outcomes and may have increased reported symptoms, according to study findings in Pediatrics.

“Because human data on postinjury exertion is limited, expert consensus recommends 24 to 48 hours of rest before beginning a stepwise return to activity,” study researcher Danny George Thomas, MD, MPH, of the Medical College of Wisconsin, and colleagues wrote. “Many clinicians recommend a longer period of rest, and some clinicians have advocated ‘cocoon therapy,’ which restricts patients to several days in a darkened room before slowly returning to activity. To date, the optimal period of rest after concussion is unknown.”

Patients, aged 11 to 22 years, who presented to the pediatric ED within 24 hours of concussion, were randomly assigned a physician recommendation for 5 days of strict rest (n=45) or the usual 24 to 48 hours of rest (n=43). Cognition and balance were assessed 3 and 10 days after injury. Study participants recorded daily activity and rated symptom severity in diaries.

During the 10-day follow-up, symptoms resolved in 67% of patients in the usual care group and 63% of patients in the strict rest group. It took 3 additional days, however, for 50% of the strict rest group to report symptom resolution vs. the usual care group.

Compared with patients who received usual care, patients in the strict rest group reported higher total symptom severity scores (131.9 vs. 187.9; P<.03), a greater total number of symptoms (50.2 vs. 70.4; P<.03) and a higher mean daily symptom severity 4 days after concussion.

Neurocognitive tests and balance scores did not differ between groups on day 3 or 10.

“Recommending strict rest from the ED did not improve symptom, neurocognitive, and balance outcomes in youth diagnosed with concussion,” Thomas and colleagues wrote. “Surprisingly, adolescents who were recommended strict rest after injury reported more symptoms over the course of this study.”

Although the study findings add to the research recommending required rest after a concussion, optimal duration remains unknown, according to William P. Meehan III, MD, and Richard G. Bachur, MD, of Boston Children’s Hospital.

“In light of current consensus recommendations, previous investigations, and the study by Thomas et al, a recommendation of reasonable rest for the first few days after a concussion followed by a gradual resumption of cognitive activities seems prudent,” Meehan and Bachur wrote in an accompanying editorial.

For more information:

Meehan WP. Pediatrics. 2015;doi:10.1542/peds.2014-3665.

Thomas DG. Pediatrics. 2015;doi:10.1542/peds.2014-0966.

Disclosure: Meehan reports financial ties with ABC-Clio, Wolters Kluwer and the National Football League Players Association. Bachur reports financial ties with Wolters Kluwer and Lippincott Williams & Wilkins. The other researchers report no relevant financial disclosures.