Research Reports - Effect of cognitive activity level on duration of post-concussion symptoms

Pediatrics. 2014 Feb;133(2):e299-304

Brown NJ, Mannix RC, O'Brien MJ, Gostine D, Collins MW, Meehan WP 3rd

OBJECTIVE: To determine the effect of cognitive activity level on duration of
post-concussion symptoms.
METHODS: We conducted a prospective cohort study of patients who presented to a
Sports Concussion Clinic within 3 weeks of injury between October 2009 and July
2011. At each visit, patients completed a scale that recorded their average level
of cognitive activity since the previous visit. The product of cognitive activity
level and days between visits (cognitive activity-days) was calculated and
divided into quartiles. Kaplan-Meier Product Limit method was used to generate
curves of symptom duration based on cognitive activity level. To adjust for other
possible predictors of concussion recovery, we constructed a Cox proportional
hazard model with cognitive activity-days as the main predictor.
RESULTS: Of the 335 patients included in the study, 62% were male, 19% reported a
loss of consciousness, and 37% reported experiencing amnesia at the time of
injury. The mean age of participants was 15 years (range, 8-23) and the mean
number of previous concussions was 0.76; 39% of athletes had sustained a previous
concussion. The mean Post-Concussion Symptom Scale score at the initial visit was
30 (SD, 26). The overall mean duration of symptoms was 43 days (SD, 53). Of all
variables assessed, only total symptom burden at initial visit and cognitive
activity level were independently associated with duration of symptoms.
CONCLUSIONS: Increased cognitive activity is associated with longer recovery from
concussion. This study supports the use of cognitive rest and adds to the current
consensus opinion.

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