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American Academy of Pediatrics
Article

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

Danny George Thomas, Jennifer N. Apps, Raymond G. Hoffmann, Michael McCrea and Thomas Hammeke
Pediatrics January 2015, peds.2014-0966; DOI: https://doi.org/10.1542/peds.2014-0966
Danny George Thomas
Departments of aPediatrics,
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Jennifer N. Apps
bPsychiatry and Behavioral Medicine, and
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Raymond G. Hoffmann
Departments of aPediatrics,
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Michael McCrea
cNeurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Thomas Hammeke
bPsychiatry and Behavioral Medicine, and
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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.

  • concussion
  • brain injury
  • rest
  • discharge instructions
  • adolescent
  • Accepted November 5, 2014.
  • Copyright © 2015 by the American Academy of Pediatrics
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Pediatrics
Vol. 147, Issue 1
1 Jan 2021
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Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial
Danny George Thomas, Jennifer N. Apps, Raymond G. Hoffmann, Michael McCrea, Thomas Hammeke
Pediatrics Jan 2015, peds.2014-0966; DOI: 10.1542/peds.2014-0966

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Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial
Danny George Thomas, Jennifer N. Apps, Raymond G. Hoffmann, Michael McCrea, Thomas Hammeke
Pediatrics Jan 2015, peds.2014-0966; DOI: 10.1542/peds.2014-0966
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Subjects

  • Emergency Medicine
    • Emergency Medicine
  • Sports Medicine/Physical Fitness
    • Sports Medicine/Physical Fitness
    • Concussion

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