Importance There are limited data to guide screen time recommendations after concussion. Objective To determine whether screen time in the first 48 hours after concussion has an effect on the duration of concussive symptoms. Design, Setting, and Participants This randomized clinical trial was conducted in the pediatric and adult emergency departments of a tertiary medical center between June 2018 and February 2020. Participants included a convenience sample of patients aged 12 to 25 years presenting to the emergency department within 24 hours of sustaining a concussion. A total of 162 patients were approached, 22 patients met exclusion criteria, and 15 patients declined participation; 125 participants were enrolled and randomized. Interventions Patients were either permitted to engage in screen time (screen time permitted group) or asked to abstain from screen time (screen time abstinent group) for 48 hours after injury. Main Outcomes and Measures The primary outcome was days to resolution of symptoms, defined as a total Post-Concussive Symptom Scale (PCSS) score of 3 points or lower. Patients completed the PCSS, a 22-symptom scale that grades each symptom from 0 (not present) to 6 (severe), each day for 10 days. Kaplan-Meier curves and Cox regression modeling were used to compare the 2 groups. A Wilcoxon rank sum test was also performed among participants who completed the PCSS each day through recovery or conclusion of the study period. Results Among 125 patients with concussion, the mean (SD) age was 17.0 (3.4) years; 64 participants (51.2%) were male. A total of 66 patients were randomized to the screen time permitted group, and 59 patients were randomized to the screen time abstinent group. The Cox regression model including the intervention group and the patient's self-identified sex demonstrated a significant effect of screen time (hazard ratio [HR], 0.51; 95% CI, 0.29-0.90), indicating that participants who engaged in screen time were less likely to recover during the study period. In total, 91 patients were included in the Wilcoxon rank sum test (47 patients from the screen time permitted group, and 44 patients from the screen time abstinent group). The screen time permitted group had a significantly longer median recovery time of 8.0 days (interquartile range [IQR], 3.0 to >10.0 days) compared with 3.5 days (IQR, 2.0 to >10.0 days; P = .03) in the screen time abstinent group. The screen time permitted group reported a median screen time of 630 minutes (IQR, 415-995 minutes) during the intervention period compared with 130 minutes (IQR, 61-275 minutes) in the screen time abstinent group. Conclusions and Relevance The findings of this study indicated that avoiding screen time during acute concussion recovery may shorten the duration of symptoms. A multicenter study would help to further assess the effect of screen time exposure. Trial Registration ClinicalTrials.gov Identifier: NCT03564210.

中文翻译：

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筛查时间对脑震荡恢复的影响：一项随机临床试验。

重要性 脑震荡后指导屏幕时间建议的数据有限。目的 确定脑震荡后 48 小时内的筛查时间是否对脑震荡症状持续时间有影响。设计、地点和参与者这项随机临床试验于 2018 年 6 月至 2020 年 2 月在一家三级医疗中心的儿科和成人急诊科进行。参与者包括 24 岁以内到急诊科就诊的 12 至 25 岁患者的便利样本持续数小时的脑震荡。共接诊162例患者，22例符合排除标准，15例拒绝参与；125 名参与者被纳入并随机分配。干预 患者被允许参与屏幕时间（屏幕时间允许组）或要求在受伤后 48 小时内放弃屏幕时间（屏幕时间戒断组）。主要结果和测量 主要结果是症状消失的天数，定义为脑震荡后症状量表 (PCSS) 总分不超过 3 分。患者完成了 PCSS，这是一个 22 症状量表，将每个症状从 0（不存在）到 6（严重）分级，每天持续 10 天。Kaplan-Meier曲线和Cox回归模型用于比较2组。通过恢复或研究期结束，每天完成 PCSS 的参与者也进行了 Wilcoxon 秩和检验。结果 125例脑震荡患者中，平均（SD）年龄为17.0（3.4）岁；64 名参与者 (51.2%) 为男性。共有 66 名患者被随机分配到筛查时间允许组，59 名患者被随机分配到筛查时间禁止组。包括干预组和患者自我识别性别的 Cox 回归模型显示了屏幕时间的显着影响（风险比 [HR]，0.51；95% CI，0.29-0.90），表明参与屏幕时间的参与者较少在研究期间可能会恢复。总共有 91 名患者被纳入 Wilcoxon 秩和检验（筛查时间允许组 47 名患者，筛查时间禁止组 44 名患者）。筛查时间允许组的中位恢复时间为 8.0 天（四分位距 [IQR]，3.0 至 >10.0 天），而筛查时间为 3.5 天（IQR，2.0 至 >10.0 天；P = .03）禁欲组。屏幕时间允许组报告干预期间的中位屏幕时间为 630 分钟（IQR，415-995 分钟），而屏幕时间禁欲组为 130 分钟（IQR，61-275 分钟）。结论和相关性 本研究的结果表明，在急性脑震荡恢复期间避免筛查时间可能会缩短症状的持续时间。一项多中心研究将有助于进一步评估屏幕时间暴露的影响。试验注册 ClinicalTrials.gov 标识符：NCT03564210。结论和相关性 本研究的结果表明，在急性脑震荡恢复期间避免筛查时间可能会缩短症状的持续时间。一项多中心研究将有助于进一步评估屏幕时间暴露的影响。试验注册 ClinicalTrials.gov 标识符：NCT03564210。结论和相关性 本研究的结果表明，在急性脑震荡恢复期间避免筛查时间可能会缩短症状的持续时间。一项多中心研究将有助于进一步评估屏幕时间暴露的影响。试验注册 ClinicalTrials.gov 标识符：NCT03564210。