Overall, fewer than 1 in 5 medical practices in Massachusetts have an EHR. Even among adopters, though, doctor usage of EHR functions varied considerably by functionality and across practices. Many clinicians are not actively using functionalities that are necessary to improve health care quality and patient safety. Furthermore, among practices that do not have EHRs, more than half have no plan for adoption. Inadequate funding remains an important barrier to EHR adoption in ambulatory care practices in the United States.

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 MEASURESThe 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 RELEVANCEThe 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

ephalic index is the ratio between head width, the biparietal diameter, and head length, the anteroposterior diameter. Cephalic index can be obtained through the use of a manual caliper, skull radiography, computed tomography, or three-dimensional computed tomographic imaging. Cephalic index is a key measure that guides management of positional plagiocephaly, which is occipital flattening because of time spent on the back in infancy. The effect of supine sleeping on molding of the occipital skull is greatest at 2 to 4 months of life, and often starts to resolve as the infant gains head control and becomes more mobile. Additional risk factors for plagiocephaly include male sex, first-born child, difficult delivery, multiple births, prematurity, and torticollis. 1 The majority of plagiocephaly can be treated with behavioral interventions such as repositioning and stretching. 2 However, in severe cases, this treatment may be inadequate, and without further intervention there is a risk of retained facial asymmetry and