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Published on: January 20, 2019
Symptom-Guided Emergency Department Discharge Instructions for Children With Concussion
Talia M Brooks1, Marissa M Smith, Renee M Silvis
1From the *Department of Pediatrics, University of Connecticut School of Medicine, Farmington; Departments of †Emergency Medicine, and ‡Research, Connecticut Children's Medical Center, Hartford, CT; and §Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
New symptom-guided discharge instructions (DIs) for pediatric concussion were found helpful by caregivers for determining return to school and activity. Further research is needed to optimize these concussion DIs for potentially shorter recovery periods.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Public Health
Background:
- Concussion management in children requires clear guidance for recovery.
- Standard discharge instructions (DIs) may lack specificity for individualized care.
- Symptom-guided DIs (symptom DIs) offer a novel approach tailored to a child's ongoing symptoms.
Purpose of the Study:
- To evaluate the use and utility of novel symptom-guided DIs for pediatric concussion.
- To compare clinical outcomes between children receiving symptom DIs and standard DIs.
Main Methods:
- A randomized controlled trial involving 114 children (aged 7-17) with concussion.
- Participants received either standard DIs or symptom DIs.
- Daily symptom checklists and 7-day follow-up surveys assessed outcomes.
Main Results:
- Both DI groups showed high usage rates (92% symptom DIs, 84% standard DIs).
- Caregivers using symptom DIs found them significantly more helpful for return-to-school and activity decisions (P < 0.05).
- Persistent postconcussive symptoms were reported at 1 week in 44% (symptom DIs) and 51% (standard DIs).
Conclusions:
- Symptom-guided DIs are frequently used and valued by caregivers for guiding return-to-activity decisions.
- While helpful, symptom DIs did not significantly alter the persistence of symptoms at 1 week.
- Further large-scale studies are warranted to refine easy-to-use DIs that may shorten the postconcussive recovery period.
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.
