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Randomized Controlled Trial
. 2021 Nov 1;175(11):1124-1131.
doi: 10.1001/jamapediatrics.2021.2782.

Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial

Theodore Macnow  1   2 , Tess Curran  1 , Courtney Tolliday  2 , Kirsti Martin  2 , Madeline McCarthy  1   2 , Didem Ayturk  1 , Kavita M Babu  1   3 , Rebekah Mannix  4   5
Affiliations
Randomized Controlled Trial

Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial

Theodore Macnow et al. JAMA Pediatr. .

Abstract

Importance: There are limited data to guide screen time recommendations after concussion.

Objective: To determine whether screen time in the first 48 hours after concussion has an effect on the duration of concussive symptoms.

Design, setting, and participants: This randomized clinical trial was conducted in the pediatric and adult emergency departments of a tertiary medical center between June 2018 and February 2020. Participants included a convenience sample of patients aged 12 to 25 years presenting to the emergency department within 24 hours of sustaining a concussion. A total of 162 patients were approached, 22 patients met exclusion criteria, and 15 patients declined participation; 125 participants were enrolled and randomized.

Interventions: Patients were either permitted to engage in screen time (screen time permitted group) or asked to abstain from screen time (screen time abstinent group) for 48 hours after injury.

Main outcomes and measures: The primary outcome was days to resolution of symptoms, defined as a total Post-Concussive Symptom Scale (PCSS) score of 3 points or lower. Patients completed the PCSS, a 22-symptom scale that grades each symptom from 0 (not present) to 6 (severe), each day for 10 days. Kaplan-Meier curves and Cox regression modeling were used to compare the 2 groups. A Wilcoxon rank sum test was also performed among participants who completed the PCSS each day through recovery or conclusion of the study period.

Results: Among 125 patients with concussion, the mean (SD) age was 17.0 (3.4) years; 64 participants (51.2%) were male. A total of 66 patients were randomized to the screen time permitted group, and 59 patients were randomized to the screen time abstinent group. The Cox regression model including the intervention group and the patient's self-identified sex demonstrated a significant effect of screen time (hazard ratio [HR], 0.51; 95% CI, 0.29-0.90), indicating that participants who engaged in screen time were less likely to recover during the study period. In total, 91 patients were included in the Wilcoxon rank sum test (47 patients from the screen time permitted group, and 44 patients from the screen time abstinent group). The screen time permitted group had a significantly longer median recovery time of 8.0 days (interquartile range [IQR], 3.0 to >10.0 days) compared with 3.5 days (IQR, 2.0 to >10.0 days; P = .03) in the screen time abstinent group. The screen time permitted group reported a median screen time of 630 minutes (IQR, 415-995 minutes) during the intervention period compared with 130 minutes (IQR, 61-275 minutes) in the screen time abstinent group.

Conclusions and relevance: The findings of this study indicated that avoiding screen time during acute concussion recovery may shorten the duration of symptoms. A multicenter study would help to further assess the effect of screen time exposure.

Trial registration: ClinicalTrials.gov Identifier: NCT03564210.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Martin reported receiving grants from the Beth Israel Deaconess Department of Neonatology Foundation outside the submitted work. Dr Babu reported receiving grants from the National Institutes of Health and having contracts with the National Highway Traffic Safety Administration and the Massachusetts Department of Public Health outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Flow Diagram
PCSS indicates Post-Concussive Symptom Scale. aThe secondary analysis was performed using a Wilcoxon rank sum test at different PCSS cutoff scores for concussion recovery.
Figure 2.
Figure 2.. Kaplan-Meier Survival Curve Comparing Days Until Concussion Recovery of Screen Time Abstinent vs Screen Time Permitted Groups
Days until concussion recovery defined as a daily Post-Concussive Symptom Scale score of 3 points or lower. Shading represents 95% CIs.
Figure 3.
Figure 3.. Unadjusted Comparison of Total Daily Post-Concussive Symptom Scale (PCSS) Scores of Screen Time Permitted vs Screen Time Abstinent Groups
A total of 66 patients were in the screen time permitted group, and 59 patients were in the screen time abstinent group. Boxes reflect medians and IQRs, and whiskers represent the range of total PCSS scores in the groups at each day after injury.
See this image and copyright information in PMC

Comment in

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