From the Guidelines
Discharge instructions for a concussion patient from the ED should include rest for 24-48 hours followed by gradual return to normal activities as tolerated, with a focus on managing postconcussive symptoms and preventing further injury, as recommended by the most recent guidelines 1. The patient should be advised to refrain from strenuous mental or physical activity until they are symptom-free, and may require 2 to 3 days off work or school, as suggested by earlier studies 1. Key aspects of discharge instructions include:
- Managing cognitive and physical activity/rest
- Instructions regarding return to play/recreation and school
- Clear clinician follow-up instructions, which are considered high-level recommendations 1
- Prevention of further injury, which is crucial in reducing the risk of second impact syndrome, a potentially life-threatening condition 1
- Patient and family education and reassurance, which are key components of concussion care initiatives and ED discharge instructions, as emphasized by recent guidelines 1 The patient should also be instructed to:
- Limit screen time and mentally demanding activities initially
- Sleep in a quiet, dark room but can be awakened every 4 hours for the first 24 hours if there was loss of consciousness
- Return to the ED immediately for worsening symptoms such as increased headache, repeated vomiting, seizures, weakness/numbness, confusion, slurred speech, or difficulty walking
- Follow up with their primary care provider within 1-2 weeks
- Avoid alcohol and recreational drugs, which can worsen symptoms and delay recovery, as well as return to sports or high-risk activities only after complete symptom resolution and medical clearance, typically following a stepwise return-to-play protocol 1
From the Research
Discharge Instructions for Concussion from the Emergency Department
The discharge instructions for a patient with a concussion from the emergency department (ED) are crucial for proper management and recovery. The following points highlight the key aspects of discharge instructions:
- The use of the Acute Concussion Evaluation-Emergency Department Discharge Instructions (ACE-ED DI) has been shown to improve caregiver's knowledge of injury management, specifics about returning to school and sports activities, and outpatient follow-up 2.
- Discharge advice must be well-informed and evidence-based, including guidelines on returning to sport following a concussion 3.
- Education to improve symptom management is an essential strategy to reduce the impact of symptoms on the quality of life for persons with mild traumatic brain injury 4.
- The evaluation and management of concussion include treatment of common symptoms such as headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues 5.
- Current guidelines provide recommendations for the evaluation and management of concussion and mild traumatic brain injury (mTBI), including initial evaluation, diagnostic criteria, assessment tools, and aftercare recommendations 6.
Key Components of Discharge Instructions
The discharge instructions for a patient with a concussion should include:
- Information on symptom management and how to reduce the impact of symptoms on daily life 4.
- Guidelines on returning to school and sports activities, including gradual return to activity and monitoring for symptoms 2, 3.
- Instructions on outpatient follow-up, including scheduling a follow-up appointment with a primary care provider 2.
- Education on the importance of rest and avoiding activities that exacerbate symptoms 5.
- Information on when to seek immediate medical attention, including worsening symptoms or signs of severe injury 6.