Effects of screen time on postconcussion symptoms nonlinear

The effect of screen time on postconcussion symptoms is not linear, making moderation of screen time more effective than restriction, according to a recent study.

Physicians usually recommend that children recovering from concussion avoid screen time for 1 to 2 days, with return to screen time being gradual and tolerable. However, for some children, complete avoidance of screen time could be inadvisable, leading to social isolation or psychological distress.

The long-term effects of screen time after concussion are unknown, but tolerable use of screen time has been associated with a longer median recovery period after concussion. Benefits from screen time reduction, such as increased physical activity, also accelerate concussion recovery.

To examine the full naturalistic range of screen time and how it effects concussion recovery, investigators conducted a planned secondary data analysis of the Advancing Concussion Assessment in Pediatrics study. This study analyzed children with concussion or orthopedic injury (OI).

Participants were aged 8 to 16 years and had been admitted to the emergency department within 48 hours of concussion or OI. Criteria for participation were based on traumatic brain injury as defined by the World Health Organization.

Patients from the concussion group were excluded if they had neurologic deterioration, neurosurgical intervention, loss of consciousness for more than 30 minutes or posttraumatic amnesia for less than 24 hours, and bodily injuries with an Abbreviated Injury Scale score greater than 4. Patients from the OI group were excluded if they had acute signs and symptoms of concussion, head trauma, or injury needing surgical intervention or procedural sedation.

Follow-up occurred 7 days, 3 months, and 6 months after injury. During these follow-up periods, patients and parents reported symptoms and health behaviors.

At the first follow-up, parents reported preinjury symptoms and health behaviors of participants. Weekly reports of postconcussive symptoms also took place during the first 3 months, which became bi-weekly from months 3 to 6.

The Health and Behavior Inventory was used as the primary outcome. Cognitive and somatic symptoms were measured on 2 separate scales, in which a higher score meant greater prevalence of symptoms.

Engagement in health behaviors was measured by the Healthy Lifestyle Behaviors Questionnaire. Behaviors included physical activity and rest, cognitive activity and rest, diet, sleep, and screen time. Frequency of behaviors from children over the previous 7-day period were recorded.

There were 712 patients measured in all 4 models, with no significant differences between sex, age, preinjury history, or other demographics. The effects of screentime were significant in both the concussion and OI groups, with no major differences between the 2 groups.

Those who reported the lowest amount of screentime and those who reported the highest amount of screen time throughout the 7-to-10-day postconcussive period both saw more cognitive and somatic symptoms, as opposed to those in the median range of screen time.

Other factors had a greater effect on symptom severity than screen time, with preinjury cognitive symptoms making up 60.8% of parent-rated cognitive symptoms and 19.9% of self-rated cognitive symptoms. For somatic symptoms, rates were 21.2% for parent-rated symptoms and 9.2% for self-rated symptoms.

These results indicate that screen time does not have as significant an effect on symptoms during concussion recovery as other factors, and that low and high amounts of screen time effect symptoms at a similar rate. Investigators concluded that screen time should be moderated rather than restricted in the time following concussion.

Reference

Cairncross M, Owen Yeates K, Tang K, Madigan S, Beauchamp MH, Craig W, et al. Early postinjury screen time and concussion recovery. Pediatrics. 2022;150(5). doi:10.1542/peds.2022-056835