AOTW: Concussion
Posted on: February 3, 2015, by : Shilpa Patel
Many of you may have already seen/heard the recent RCT in Pediatrics last month on post concussion management. D. Thomas et al in Milwaukee recruited kids ages 11-22 presenting to the Peds ED within 24 hours of concussion and randomized them to “strict rest” vs “usual care” for 5 days (n = 88). Usual care was defined as 1-2 days of rest followed by a stepwise return to activity. They found that the “strict rest” group reported more daily post-concussive symptoms and slower symptom resolution. Of course the study has limitations — it’s a small study, the groups after analysis did not differ significantly in physical activity with a only a small difference in cognitive activity, and there could be reporting bias.
Summarized recommendations on concussion based on the commentary in Pediatrics from R. Bachur:
– Reasonable rest for first few days followed by a step-wise return of cognitive activities and gradual resumption of aerobic exercise as tolerated
– If still symptomatic after first few days consider further cognitive rest with academic accommodations (Concussion Clinic/PMD can manage)
– Prompt follow up with PMD or Concussion Clinic to further manage after discharge from ED to tailor management plan to individual patient