Symptom-Guided Emergency Department Discharge Instructions for Children With Concussion. Issue 8 (August 2017)

• Record Type: Journal Article
• Authors: Brooks, Talia M.; Smith, Marissa M.; Silvis, Renee M.; Lerer, Trudy; Mulvey, Christine Henry; Maitland, Ralynne; Dunn, Amy L.; Logan, Kelsey; Smith, Sharon R.
• Is Part Of: Pediatric emergency care. Volume 33:Issue 8(2017)
• Publication Date: 2017-08
• Subjects: concussion -- traumatic brain injury -- discharge instructions; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000000797
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Objectives: The objective was to evaluate the use and utility of a novel set of emergency department discharge instructions (DIs) for concussion based on a child's ongoing symptoms: symptom-guided DIs (symptom DIs). Differences in clinical outcomes were also assessed. Methods: A convenience sample of 114 children aged 7 to 17 years presenting to an urban pediatric emergency department with a complaint of concussion was assembled. Children were randomized to standard DIs or symptom DIs. Children completed a graded symptom checklist (GSC) and completed daily the GSC for 1 week. Telephone follow-up was performed at 7 days after enrollment using a standardized survey. Results: Fifty-eight children received the symptom DIs, and 56 received the standard DIs. Rates of use were similar with reported rates of 92% for symptom DIs and 84% for standard DIs. Caregivers with symptom DIs reported that the DIs were more helpful in determining when their child could return to school and physical activity ( P < 0.05) than caregivers with standard DIs. Children continued to have postconcussive symptoms days and weeks after their injury with 44% of children with symptom DIs and 51% of children with standard DIs reporting symptoms on the GSC at 1 week. Conclusions: Both study groups reported frequent use of the DIs. Caregivers with symptom DIs found them particularly helpful in determining when their child could return to school and physical activity. Larger-scale investigations are needed to further develop instructions that are easy to use and that may decrease the postconcussive period.