Original ArticlesSymptom-Guided Emergency Department Discharge Instructions for Children With ConcussionBrooks, Talia M. MD*†; Smith, Marissa M. MD†; Silvis, Renee M. MS†; Lerer, Trudy MS‡; Mulvey, Christine Henry MA†‡; Maitland, Ralynne DO*†; Dunn, Amy L. DO, MPH*†; Logan, Kelsey MD, MPH§; Smith, Sharon R. MD*† Author Information 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. Disclosure: The authors declare no conflict of interest. Reprints: Talia M. Brooks, MD, 269-01 76th Avenue, New Hyde Park, NY 11040 (e-mail: [email protected]). Pediatric Emergency Care: August 2017 - Volume 33 - Issue 8 - p 553-563 doi: 10.1097/PEC.0000000000000797 Buy Metrics Abstract Objectives The 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. Methods A 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. Results Fifty-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. Conclusions Both 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. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.