title: Retrospective Chart Analysis of Concussion Discharge Instructions in the Emergency Department.
abstract: BACKGROUND
  Recognition and diagnosis of concussion is increasing, but current research shows these patients are discharged from the emergency department (ED) with a wide variability of recommendations and instructions.
  
  
  OBJECTIVE
  To assess the adequacy of documentation of discharge instructions given to patients discharged from the ED with concussions.
  
  
  METHODS
  This was a quality-improvement study conducted at a University-based Level I trauma center. A chart review was performed on all patients discharged with closed head injury or concussion over a 1-year period. Chi-squared measures of association and Fisher's exact test were used to compare the proportion of patients receiving discharge instructions (printed or documented in the chart as discussed by the physician). Multivariable logistic regression was used to assess the relationship between whether the concussion was sport-related in relation to our primary outcomes.
  
  
  RESULTS
  There were 1855 charts that met inclusion criteria. The physician documented discussion of concussion discharge instructions in 41% (95% confidence interval [CI] 39.2-43.7) and printed instructions were given in 71% (95% CI 69.1-73.2). Physicians documented discussion of instructions more often for sport-related vs. non-sport-related concussion (58% vs. 39%, p = 0.008) with an odds ratio (OR) of 2.1 (95% CI 1.6-2.8). Discharge instructions were given more often for sport-related injuries than those without sport-related injuries (85% vs. 69%, p = 0.047), with an OR of 2.2 (95% CI 1.6-3.1). Children were more likely to have had physician-documented discussion of instructions (56%, 95% CI 52.3-59.1 vs. 31%, 95% CI 28.0-33.6), printed discharge instructions (86%, 95% CI 83.2-88.1 vs. 61%, 95% CI 57.6-63.4), and return-to-play precautions given (11.2%, 95% CI 9.2-13.6 vs. 4.5%, 95% CI 3.4-5.9) compared with adults.
  
  
  CONCLUSIONS
  Documentation of discharge instructions given to ED patients with concussions was inadequate, overall.
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Allison D
authors.initials: AD
authors.lastname: Lane
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Berkman
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: David
authors.initials: D
authors.lastname: Verbunker
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Taylor
authors.initials: T
authors.lastname: Shekell
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Michael
authors.initials: M
authors.lastname: Bouska
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Lauren
authors.initials: L
authors.lastname: Barnett
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Allie
authors.initials: A
authors.lastname: Keogh
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Tomas
authors.initials: T
authors.lastname: Nuno
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Uwe
authors.initials: U
authors.lastname: Stolz
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Waterbrook
mesh_terms: D000293:Adolescent; D000328:Adult; D001130:Arizona / Q000453:epidemiology; D001265:Athletic Injuries / Q000453:epidemiology; D001924:Brain Concussion / Q000453:epidemiology / Q000628:therapy*; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D063886:Patient Discharge Summaries / Q000592:standards* / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data
keywords: closed head injury; concussion; sports medicine