Kids May Not Benefit From Extended Isolation After Concussions

Transcript

MELISSA BLOCK, HOST:

If a child suffers a concussion, standard care involves strict rest at home, no school, no physical activity. But how much rest? How many days? Well, a new study published in the journal Pediatrics says more rest is not necessarily better. Dr. Danny Thomas led the study. He's a pediatric emergency medicine doctor at Children's Hospital of Wisconsin. Dr. Thomas welcome to the program.

DANNY THOMAS: Hi, thank you very much.

BLOCK: And first of all, what was your assumption going into this study?

THOMAS: When we started the study, we really thought that rest would be better, and that's why we thought to test more rest up front being helpful in improving concussion outcomes.

BLOCK: OK, well, you studied 88 patients ages 11 to 22, all of whom were diagnosed with concussions, discharged from the ER. Right?

THOMAS: Correct.

BLOCK: And half of them were sent home, told to rest for one or two days; the other half told to rest for five days.

THOMAS: Yes.

BLOCK: What did you find?

THOMAS: The group that was told to rest for five days did not have better outcomes at the 10-day mark. Their neurocognitive outcomes were the same, so as were their balance outcomes. What was more surprising is we found that they actually had complained of more symptoms throughout the whole course of the study. Specifically in the first few days, they had more physical symptoms, like headache and nausea. And then over the course of the study, they complained of more emotional symptoms, irritability and sadness.

BLOCK: What would explain that, when you think about those symptoms that this group that was told to rest for longer reported having?

THOMAS: Well, I think what explains it is that, you know, they're teenagers largely, and they're told to sit at home. And school has a social aspect to it. And I think that they perseverate on their symptoms or dwell on them, much like a toothache. So when you have a toothache, it hurts you in the daytime, but it hurts you most at night when you're trying to sleep and there's no distractions.

BLOCK: One of the other ideas, a possibility raised by another doctor, was that the patients who were told to stay home for five days may have assumed, well, I'm sicker, and that that could have influenced what they reported - reporting bias, basically.

THOMAS: It may have. But the fact that they were randomized to that group meant that we were randomly assigning them to that role so that they assumed that sick role, then, from our random assignment, which may suggest that there is some sort of role in how we frame the injury so as not to influence their outcome.

BLOCK: One thing that you do point out in your study, Dr. Thomas, is that the young people who were told to rest for five days simply had more time to fill out the symptom diary. So they may have been better reporters than the kids who were told, go back to school after one or two days.

THOMAS: That is true. There could be that reporting bias just from the mechanics of the study itself. But in the end, that's actually where I would say is the most important aspect, is that they didn't really have a difference in their outcome. So five days of rest didn't really make them better and actually delayed the time that it took to get them back to their school and back to the normal activities.

BLOCK: So, Dr. Thomas, what's your advice to parents who have a child who they think may be concussed? What do you tell them?

THOMAS: First, I think your child needs to be evaluated if you think that they have suffered a concussion by a physician, and that physician can make a determination whether your child has a concussion or has a more significant brain injury. Once that determination has been made that your child has more of a mild traumatic brain injury, then I think that we would recommend one or two days of rest until the symptoms start to get better, then starting to resume normal activities slowly in a stepwise fashion.

BLOCK: Does that also apply to adults with concussions or just to young people that you studied?

THOMAS: I think that this only applies to adolescents at this point. I don't think we have enough data for adults to be able to make the same generalizations. I think that there's probably going to be a lot of similarity, but an adult study would have to be done to really determine that.

BLOCK: Well, Dr. Thomas, thanks so much for talking with us.

THOMAS: Oh, no problem. Thank you very much.

BLOCK: That's Danny Thomas. He teaches at the Medical College of Wisconsin, and he's a pediatric emergency medicine doctor at Children's Hospital of Wisconsin. The hospital study of rest time for young people with concussions is in the journal Pediatrics. Transcript provided by NPR, Copyright NPR.