Written discharge instruction evaluation for mild traumatic brain injury from emergency departments Evaluating written discharge instructions from emergency departments for mild traumatic brain injury

Aim of study: This study aimed to evaluate the completeness and quality of information in written discharge instructions for patients with mild traumatic brain injury (mTBI) discharged from the emergency department (ED).

Methods: Copies of written discharge instructions provided to patients with mTBI from academic EDs in South Korea were collected in May 2023. We assessed the completeness of the content based on the National Institute for Health and Clinical Excellence guidelines, which categorize discharge instructions into four parts: general advice, emergencies, common post-concussion symptoms and signs, and advice for recovery, with one point for each item. The quality of information was evaluated using DISCERN, a validated 16-item questionnaire assessing reliability (eight questions), quality of information (seven questions), and overall quality (one question) on a 5-point Likert scale. Completeness and quality of discharge information were analyzed by ED level and annual ED visits as proxies for hospital resources.

Results: Twenty-two (44%) written discharge instructions were collected from the 55 EDs contacted, with a mean (standard deviation) content completeness score of 10.1 (2.7) out of a maximum of 30. The mean scores for each section were as follows: general advice, 0.1 (0.23) out of 2; emergencies, 6.0 (1.39) out of 10; common post-concussion symptoms and signs, 0.4 (0.9) out of 8; and advice for recovery, 3.2 (1.9) out of 10. Regarding the quality of information, the mean reliability score was 3.5 (0.3), and the mean information quality score was 1.8 (0.7), with both assessed on a scale from 1 ("very poor") to 5 ("excellent"). Significant differences were found in content completeness for emergency features and in the general scores for quality of information between different ED levels (p = 0.04 and p = 0.01, respectively). However, no significant differences were observed by the number of annual ED visits.

Conclusion: The completeness and quality of written discharge instructions for mTBI patients in South Korean EDs were low and varied across hospitals, suggesting a potential association to hospital resources.