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Scenario
A 14-year-old girl attends A&E after hitting her head on a concrete wall during netball, with short loss of consciousness. She is discharged after a normal CT head. She returns the next day with symptoms of concussion. Her mum asks if avoiding screens would be helpful.
Structured clinical question
In a 14-year-old girl with concussion (patient), does limiting screen time (intervention) improve symptom recovery (outcome)?
Search
Sources: Embase, Ovid MEDLINE
Search strategy: concussion AND (screen time OR screentime OR cognitive rest)
Number of hits: 200
Relevant hits: 14
Why excluded?
Duplicates 67
Not relevant 77
Not English language 2
Non-systematic reviews or guidelines 40
Studies were excluded if not explicitly mentioning screen time of some sort, or those only focusing on adults or post-concussion syndrome. Guidelines and non-systematic review articles were also excluded. The selected articles are summarised in table 1.
Articles included in assessment3 4 10–21
Commentary
Concussion is a traumatic brain injury induced by biomechanical forces.1 Rates of sports-related and non–sports-related concussion are high and rising—there are up to 3.8 million episodes of sports-related concussion each year in the USA alone.2 Sports-related concussion occurs in a range of activities, both contact and non-contact, with studies showing high rates in ice hockey, American football, basketball, football, lacrosse, skiing, snowboarding and rugby.3–5 In most cases, symptoms will resolve within 2 weeks, but longer-term problems such as post-concussion syndrome can develop.1
Although there are many clinical and sporting guidelines that include reducing screen time during recovery from concussion,1 6–9 there is minimal good evidence for this. The studies assessed showed conflicting results around the effect of screen time on symptom resolution—some showed limiting screen time improved symptoms or symptom duration,3 10–13 some showed limiting screen time worsened symptoms,14 15 but the majority showed no clear relationship.4 16–21 Part of this conflict may be due to variations and ambiguity in the definition and measurement of screen time.
It is also important to remember the other negative impacts limiting activities such as screen time can have on patients, such as through psychological effects with loss of social interaction—loss of activity was one of the worst parts of concussion for nearly three-quarters of young patients.22 Strict rules might impact compliance as a result.
In some studies, despite exploring screen time as part of cognitive rest for concussion, the interventions themselves, or means of following individuals up, involved screen time.16 19 This makes interpretation harder, but also implies that the authors are not entirely concerned by screen time.
Apart from reduction in screen time itself, one study mentioned reducing screen brightness as a beneficial measure to improve symptoms.16 One review article mentioned this alongside other adaptations such as increasing font size on electronics, although without an evidence base.23
Of note, all 15 papers included are American in origin. This may be related to their widespread legislation around concussion24 but may mean their research is not as relevant to populations with differences in healthcare and common sports.
An ongoing trial is exploring the impact of screen time in recovery from concussion currently,25 and we await their conclusions. Until then, consensus is growing for a focus on individualised care rather than blanket advice for or against limiting screen time—if screens are increasing symptoms, such as headache, fatigue, nausea, poor concentration, poor balance/coordination or sensitivity to light/noise,26 it is likely appropriate to reduce exposure.
Clinical bottom lines
There is minimal evidence for reducing screen time specifically, but it is included in several guidelines as part of cognitive rest (Grade D).
A personalised approach, limiting any activity that worsens symptoms—such as headache, fatigue, nausea, poor concentration, poor balance/coordination, and sensitivity to light/noise—in the child, which might include screen time, is more useful (Grade D).
Ethics statements
References
Footnotes
Twitter @_katieknight_
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.