Pediatric Concussion: Cognitive Activity and Time to Recovery

In a prospective cohort study of patients presenting to a sports concussion clinic at Boston Children's Hospital within 3 weeks of injury, investigators evaluated the impact of cognitive rest on duration of post-concussion symptoms. The Post-Concussion Symptom Scale (PCSS) was used to assess symptoms at follow-up visits. Patients were considered recovered when they were symptom-free at rest and with exertion and when both balance error symptom scores and neurocognitive test scores normalized.

At each visit, patients rated their cognitive activity on a scale from 0 to 4, with 4 indicating no restrictions and 0 indicating no participation in reading, homework, text messaging, video game playing, online activity, crossword puzzles, or similar activities. Noncognitive activities included watching television or movies and listening to music. Cognitive activity days were calculated as the average cognitive activity level since the last visit multiplied by the number of days between visits.

Between 2009 and 2011, 335 patients (age range, 8 to 23 years) presented for follow-up. The mean total duration of symptoms was 43 days. PCSS scores at the initial follow-up visit and cognitive activity days were independently associated with duration of symptoms (hazard ratios, 0.98 and 0.99, respectively). Patients in the highest quartile of cognitive activity days took significantly longer to recover than others, while those in the lower three quartiles had similar recovery curves. Age, loss of consciousness, amnesia, and previous concussions were not associated with time to recovery.