Cognitive Rest for Concussion Questioned

Short Attention Span Summary

Sprained brain causes pain
After concussion, physical and cognitive rest are prescribed to speed the healing and recovery process, but this study questions whether or not this helps.  This was a RCT of 118 adults with mild traumatic brain injury (TBI), half of which got discharge instructions for cognitive rest and graduated return to full physical activity vs usual discharge instructions.  They found no difference in post-concussion symptom score at 2 and 4 weeks.  The problem is, how many patients actually paid attention to their discharge instructions or even read them?  This study may have found that both groups didn't read, understand, or follow discharge instructions rather than finding a failure of cognitive rest after concussion.

Spoon Feed
This study does not change my practice.  Neurons are injured in concussion and need to heal.  Excessive physical and cognitive load makes people with concussion feel worse.  It only makes sense to tell people with concussion they have a sprained brain, and like a sprained ankle, they need to rest to allow time for healing.


Abstract

Acad Emerg Med. 2016 Oct 28. doi: 10.1111/acem.13073. [Epub ahead of print]

Cognitive rest and graduated return to usual activities versus usual care for mild traumatic brain injury: A randomized controlled trial of emergency department discharge instructions.

Varner CE1,2,3, McLeod S4,5, Nahiddi N4, Lougheed RE4, Dear TE5, Borgundvaag B4,6,5.

Author information:

1Department of Family and Community Medicine, University of Toronto, Toronto, Canada. CVarner@mtsinai.on.ca.

2Department of Emergency Medicine, Mount Sinai Hospital, Toronto, Canada. CVarner@mtsinai.on.ca.

3Schwartz / Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Canada. CVarner@mtsinai.on.ca.

4Department of Family and Community Medicine, University of Toronto, Toronto, Canada.

5Schwartz / Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Canada.

6Department of Emergency Medicine, Mount Sinai Hospital, Toronto, Canada.

Abstract

INTRODUCTION:

It is estimated 15-25% of patients with a mild traumatic brain injury (MTBI) diagnosed in the emergency department (ED) will develop post-concussive syndrome (PCS). The objective of this study was to determine if patients randomized to graduated return to usual activity discharge instructions had a decrease in their Post-Concussion Symptom Score (PCSS) 2 weeks after MTBI compared to patients who received usual care MTBI discharge instructions.

METHODS:

This was a pragmatic, randomized trial of adult (18-64 years) patients of an academic ED (annual census 60,000) diagnosed with MTBI occurring within 24 hours of ED visit. The intervention group received cognitive rest and graduated return to usual activity discharge instructions, and the control group received usual care discharge instructions that did not instruct cognitive rest or graduated return. Patients were contacted by text message or phone 2 and 4 weeks post ED discharge and asked to complete the PCSS, a validated, 22 item questionnaire, to determine if there was a change in their symptoms. Secondary outcomes included change in PCSS at 4 weeks, number follow-up physician visits, and time off work/school.

RESULTS:

118 patients were enrolled in the study (58 in the control group and 60 in the intervention). Mean age was 35.2 (13.7) years and 43 (36.4%) were male. There was no difference with respect to change in PCSS at 2 weeks (10.5 vs 12.8; ∆ 2.3, 95% CI: 7.0, 11.7) and 4 weeks post-ED discharge (21.1 vs 18.3; ∆ 2.8, 95% CI: 6.9, 12.7) for the intervention and control groups, respectively. The number follow-up physician visits and time off work/school was similar when the groups were compared. Thirty-eight (42.2%) and 23 (30.3%) of patients in this cohort had ongoing on-going MTBI symptoms (PCSS > 20) at 2 weeks and at 4 weeks, respectively.

CONCLUSIONS:

Results from this study suggest graduated return to usual activity discharge instructions do not impact rate of resolution of MTBI symptoms 2 weeks after ED discharge. Given patients continue to experience symptoms 2 and 4 weeks after MTBI, more investigation is needed to determine how best to counsel and treat patients with post-concussive symptoms. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

PMID: 27792852 [PubMed - as supplied by publisher]