Is Cognitive Rest Following a Head Injury Associated with Prolonged Concussion Symptoms?

Background: Recent studies have suggested that cognitive rest may not lead toward a faster recovery from acute concussions. Furthermore, the latest international consensus concussion guidelines note the appropriate amount of cognitive rest remains undetermined. Additionally, somatization has recently been shown to be a risk factor for prolonged concussion symptoms (PCS). Objective: Our objective was to determine the relationship between cognitive rest and PCS. Additionally, we sought to determine the relationship between somatization and PCS, while also considering the interaction with cognitive rest. Design/Methods: A prospective cohort study of 5-18 year olds diagnosed with an acute concussion in a tertiary care children’s hospital emergency department was conducted from January through December 2017. Participants completed the post-concussion symptom inventory (PCSI) and Children’s Somatization Inventory (CSI) at diagnosis. Emergency department provider recommendations on rest from school were collected. Follow-up calls were completed at 1 week to determine time off from school as a proxy of cognitive rest. Rest was categorically analyzed. PCSI scores were re-assessed at 4 weeks. Results: A total of 89 patients have been enrolled with a median age of 10.0 (IQR: 8.5-13.0). 58% (N=52) of the patients are male. 82.0% (N=73) completed 7-day follow-up. 24.7% (N=18) of patients took no time off from school; 42.5% (N=31) took 1-2 days off; and 32.9% (N=24) took 3 or more days off from school. 24% had prolonged concussion symptoms. Logistic regression analysis was used to compare the rest tertiles to PCS, with no time off as the reference category. When compared to the shortest rest tertile, the longest rest tertile had a 1.35 fold increase in prolonged concussion symptoms, which was not statistically significant (95% CI: 0.31 – 5.91). When compared to the shortest rest tertile, the medium rest tertile had a 0.50 fold decrease in prolonged concussion symptoms, which was also not statistically significant (95% CI: 0.10 – 2.42). In the longer rest tertiles, somatization scores trended higher in the group with PCS (p = 0.15). Conclusion(s): In our preliminary pilot data, patients who took more time off from school did not show decreased likelihood of prolonged concussion symptoms. Furthermore, patients with somatization may be at particular risk of rest associated with prolonged concussion symptoms. Further larger scale studies, including randomized trials, are necessary to determine the risk of rest on prolonged concussion symptoms