• Talia M Brooks, Marissa M Smith, Renee M Silvis, Trudy Lerer, Christine Henry Mulvey, Ralynne Maitland, Amy L Dunn, Kelsey Logan, and Sharon R Smith.
• From 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.
• Pediatr Emerg Care. 2017 Aug 1; 33 (8): 553-563.

ObjectivesThe 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.MethodsA 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.ResultsFifty-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.ConclusionsBoth 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.

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