Less Screen Time Postconcussion Leads to Faster Recovery for Young Adults

An eleven-year-old boy playing online games on his digital tablet in his bedroom at home.
In a randomized clinical trial, researchers sought to determine the effect of screen time during the first 48 hours following a concussion on the duration of concussive symptoms.

An abstinence of screen time in the first 48 hours after a concussion is associated with a significantly faster recovery among patients aged 12 to 25 years, according to a study published in JAMA Pediatrics.

After the first 24 to 48 hours of sustaining a concussion, the International Concussion in Sports Group and the Centers for Disease Control and Prevention recommends cognitive and physical rest. This should be followed by a structured plan to return to activity. However, there is limited data when it comes to screen time recommendations following a concussion. The objective of the current study was to determine whether the use of screen time can induce concussive symptoms and delay recovery.

The single-center, randomized, clinical trial, The Effect of Screen Time on Recovery From Concussion, (ClinicalTrials.gov Identifier: NCT03564210) enrolled patients from June 2018 to February 2020. Eligible participants were aged 12 to 25 years, presented to the emergency department within 24 hours of a head injury, and met the criteria for concussion on the Acute Concussion Evaluation–Emergency Department tool.

The patients were randomized to 1 of 2 intervention groups—1 group was permitted to engage in screen time during the first 48 hours of recovery, and 1 group was asked to abstain from screen time in this same period.

The primary outcome was the number of days until achieving a functional resolution of concussive symptoms, which was a score of 3 points or lower on the Post-Concussive Symptom Scale (PCSS). The participants completed a daily screen time survey and the PCSS for 3 calendar days after discharge.

A total of 125 patients (mean [SD] age, 17.0 [3.4] years; 64 male [51.2%]) were included. The group that was permitted screen time included 66 participants (56.1% male), and the group that abstained from screen time included 59 participants (45.8% male).

Participants’ median PCSS score at enrollment was 21.0 points (interquartile range [IQR], 8.0-39.0) in the screen time–permitted group and 24.5 points (IQR, 11.0-38.0) in the screen time–abstinent group, with 49.6% of all concussions occurring during sports activities.

Cox regression showed that female participants (hazard ratio [HR], 0.34; 95% CI, 0.19-0.60) and participants in the screen time–permitted group (HR, 0.51; 95% CI, 0.29-0.90) were less likely to recover during the study period compared with male participants and those in the screen time–abstinent group.

A Wilcoxon rank sum test was conducted in 91 patients (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 time until recovery vs the screen time–abstinent group (8.0 days [IQR, 3.0 to >10.0 days] vs 3.5 days [IQR, 2.0 to >10.0 days], respectively; P =.03).

The screen time–permitted group had more overall screen time (median, 630 minutes [IQR, 415-995]) compared with the screen time–abstinent group (median, 130 minutes [IQR, 61-275]).

Study limitations include the single-center design, which could limit the generalizability of the findings. Also, the analysis was based on self-reported screen time, and only 40 participants in each group completed all 3 screen time surveys.

“This randomized clinical trial found that abstaining from screen time in the acute period after concussion may be associated with a shorter duration of symptoms, which supports clinical recommendations to limit screen time in the acute period after concussion,” concluded the researchers. “A multicenter study would help to further assess the effect of screen time exposure.”

Reference

Macnow T, Curran T, Tolliday C, et al. Effect of screen time on recovery from concussion: a randomized clinical trial. JAMA Pediatr. Published online September 7, 2021. doi: 10.1001/jamapediatrics.2021.2782