Retrospective Chart Analysis of Concussion Discharge Instructions in the Emergency Department

Allison D. Lane, Matthew R. Berkman, David Verbunker, Taylor Shekell, Michael Bouska, Lauren Barnett, Allie Keogh, Tomas Nuno, Uwe Stolz, Anna L. Waterbrook

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)690-698
Number of pages9
JournalJournal of Emergency Medicine
Issue number5
StatePublished - May 2017


  • closed head injury
  • concussion
  • sports medicine

ASJC Scopus subject areas

  • Emergency Medicine


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