The Effectiveness of Prescribed Rest Depends on Initial Presentation After Concussion

Objective To evaluate if patients with signs of injury respond differently to prescribed rest after concussion compared with patients with symptoms only. Study design Secondary analysis was completed of a prospective randomized controlled trial (NCT01101724) of pediatric concussion patients aged 11-18 years. Patients completed computerized neurocognitive testing and standardized balance assessment at the emergency department within 24 hours of injury and on follow-up (3 and 10 days). Patients were randomized to rest or usual care and completed activity and symptom diaries for 10 days after injury. A series of 2 x 2 ANOVAs with grouping factors of patient group (symptoms, signs) and treatment arm (prescribed rest, standard of care) were used to examine differences on clinical measures. Univariate nonparametric test (ie, X-2 with ORs and 95% CIs) was used to examine the association between treatment arm and symptom status 1-9 days after injury. Results A 2 x 2 factorial ANOVA revealed a significant patient group x treatment arm interaction for symptom score at 3 days after injury (F = 6.31, P = .01, eta(2) = 0.07). Prescribed rest increased the likelihood of still being symptomatic at days 1-6 and 8 (P < .05) for the symptoms group. Rest was beneficial for patients in the signs group on verbal memory performance (t = -2.28, P = .029), but not for the symptoms group. Conclusion Compared with patients with signs of injury, patients with predominantly symptoms were more likely to remain symptomatic after injury if prescribed rest, whereas patients with signs of injury benefited from rest after a concussion. Individualized treatment planning after concussion should start in the emergency department.