Emergency department physicians currently suggest that pediatric patients rest for one to two days following a concussion, but some practitioners had begun suggesting longer periods of rest and restricted activities. Now, a new study published in Pediatrics shows that strict bed rest offers no additional neurocognitive, balance or symptom benefit.

Because of their active lifestyles, children and teens are more likely to suffer traumatic brain injuries (TBIs), including concussions, than are adults. Emergency department physicians treat more than 173,285 cases of adolescent TBIs each year, according to the Centers for Disease Control and Prevention, with the highest rates of adolescent TBI associated with football (55,007) and girl's soccer (29,167).

Some physicians have started recommending "cocoon therapy" for children who suffer concussions. During cocoon therapy, pediatric patients stay in a darkened room for several days following concussion. The patients are not allowed to text and may only leave the room for meals. This new study suggests that practice may do more harm than good.

In the study, researchers recruited patients aged 11 to 22 years who had presented to a pediatric ED with mild TBI/concussion (mTBI) within 24 hours between May 2010 and December 2012. The study took place at Children's Hospital of Wisconsin Emergency Department and Trauma Center.

The most common cause of injury was related to sports, especially football. About one-third of participants reported loss of consciousness.

Practitioners defined mTBI by using the Acute Concussion Evaluation (ACE) form and performed neurocognitive, balance and symptom assessment before randomly assigning participants to two groups. Participants in the intervention group adhered to strict rest protocol for five days, while subjects in the control group rested for only one to two days before returning to activity in a stepwise fashion.

Participants noted their physical and mental activity level, calculated energy exertion and recorded any symptoms in a diary. The investigators performed neurocognitive and balance assessments at three days post-injury and again after 10 days.

The researchers performed powered sample-size calculations to identify meaningful differences in neurocognitive, symptom and balance scores between the two groups. The investigators employed linear mixed modeling to account for contribution of group assignment as it pertained to individual trajectory.

After discharge from the emergency department, subjects in both groups reported a 20 percent decrease in energy exertion and physical activity levels.

The intervention group reported less school and after-school attendance during days 2 through 5 post-concussion than did the control group (3.8 vs 6.7 hours total). There were no clinically significant differences in balance outcomes or neurocognitive outcomes between the two groups.

The intervention group did report more daily post-concussive symptoms than did participants in the control group (total symptom score over 10 days, 187.9 vs 131.9) and demonstrated slower symptom resolution.

Recommending strict rest for pediatric patients immediately after concussion does not provide any additional benefits when compared with usual care. In this study, the researchers also found that recommending strict rest influences symptom reporting among adolescents with concussion.