Reliability of home observation for victims of mild closed-head injury

Victims of mild closed-head injury who do not require hospitalization frequently are observed at home. The efficacy of home observation for such cases and the extent to which after-care management plans are executed in this setting, however, are unknown. We studied 47 consecutive victims of mild closed-head injury discharged from the emergency department for home observation under the care of a responsible individual with a set of written after-care instructions for management. The instructions were reinforced verbally by ED staff before discharge. Followup was performed within 24 hours by telephone, and a questionnaire was sent. Three patterns emerged. Nine patients (19%), Group A, denied having received written after-care instructions despite documentation to the contrary in the medical record. Seventeen patients (36%), Group B, received the instructions alone and were told to convey them to the individual responsible for performing the home management. In the remaining 21 cases (45%), Group C, the instructions were given directly to the individual responsible for providing the home management. Although the after-care management plan specified observing or awakening the patient every two hours, this was done in only two patients (22%) in Group A and in four patients (24%) in Group B (NS). Fourteen patients (67%) in Group C, by comparison, were observed correctly as specified by the after-care instructions (P less than .02). No one in Group A could recall more than two of the eight items in the after-care management plan, and only three individuals (18%) in Group B (NS), could recall more than two items.(ABSTRACT TRUNCATED AT 250 WORDS)