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Improved Concussion Discharge Instructions in a Pediatric Emergency Department

Ryan P Keenan1, Kathleen Lovanio, Garry Lapidus

  • 1Emergency Department (Drs Keenan, Lapidus, and Smith and Ms Chenard) and Injury Prevention Center (Mr Lapidus), Connecticut Children's Medical Center, Hartford; and Fairfield University, Connecticut (Dr Lovanio).

Advanced Emergency Nursing Journal
|January 31, 2020
PubMed

Insights

The Acute Concussion Evaluation-Emergency Department Discharge Instructions (ACE-ED DI) significantly improved caregiver understanding of pediatric concussion management, return-to-activity guidelines, and follow-up care compared to standard instructions.

Area of Science:

  • Pediatric Emergency Medicine
  • Neuroscience
  • Public Health

Background:

  • Pediatric concussions are a common injury requiring emergency department visits.
  • Effective discharge instructions are crucial for managing pediatric concussions and ensuring proper recovery.
  • Current standard discharge instructions may not fully equip caregivers with necessary knowledge.

Purpose of the Study:

  • To evaluate the impact of the Acute Concussion Evaluation-Emergency Department Discharge Instructions (ACE-ED DI) on caregiver knowledge.
  • To assess improvements in understanding concussion management, return-to-school, return-to-sports, and follow-up care.
  • To compare the effectiveness of ACE-ED DI combined with standard instructions versus standard instructions alone.

Main Methods:

  • A quasi-experimental study was conducted in a pediatric emergency department.
  • Caregivers of children (5-18 years) with concussions were surveyed before and after receiving different discharge instructions.
  • Two phases were implemented: standard discharge instructions (SDIs) followed by SDIs plus ACE-ED DI, with a 16-item survey to measure understanding.

Main Results:

  • Caregivers receiving ACE-ED DI reported a 24% increase in the helpfulness of materials (p < 0.001).
  • Perceived understanding of concussion management and return-to-activity guidelines increased by 25% and 23% respectively (p < 0.001).
  • There was a 17% increase in the likelihood of follow-up with a primary care provider (p < 0.001).

Conclusions:

  • The ACE-ED DI is a more effective tool than standard discharge instructions for enhancing caregiver knowledge of pediatric concussion.
  • Implementing ACE-ED DI in emergency departments can improve concussion injury management and adherence to follow-up care.
  • Enhanced discharge instructions are vital for optimizing recovery and reducing potential complications from pediatric concussions.

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