To evaluate the effect of cognitive and physical rest on persistent post-concussive symptoms (PPCS) in a pediatric population.
A prospective cohort study of 5-18-year-olds diagnosed with an acute concussion in a tertiary care pediatric emergency department was conducted from December 2016 to May 2019. Participants (N = 119) were followed over one month to track days off from school and sports and the development of PPCS (residual concussion symptoms beyond one month). Participants were dichotomized into minimal (≤2) and moderate (>2) rest, based on days off from school and sports following concussion. Univariate and multivariable logistic regression analyses were completed to examine associations with PPCS.
24% of the participants in our study had PPCS. Adolescent age, history of prolonged concussion recovery, and headache at presentation were associated with higher odds of PPCS in univariate analyses. In a multivariable logistic regression model, only adolescent age was associated with increased odds of PPCS. Compared with the minimal cognitive rest group, moderate cognitive rest did not decrease the odds of PPCS (adjusted OR = 1.15, 95% CI 0.44, 2.99). Compared with the minimal physical rest group, moderate physical rest also did not decrease the odds of PPCS (adjusted OR = 3.17, 95% CI 0.35, 28.78).
Emerging evidence supports early return to light activity for recovery of acute pediatric concussion. Our study adds to this management approach as we did not find that rest from school and sports resulted in a decreased odds of PPCS.

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