Keenan Ryan P, Lovanio Kathleen, Lapidus Garry, Chenard Danielle, Smith Sharon
Emergency Department (Drs Keenan, Lapidus, and Smith and Ms Chenard) and Injury Prevention Center (Mr Lapidus), Connecticut Children's Medical Center, Hartford; and Fairfield University, Connecticut (Dr Lovanio).
Adv Emerg Nurs J. 2020 Jan/Mar;42(1):63-70. doi: 10.1097/TME.0000000000000280.
Pediatric concussions are common and many children seek care in emergency departments. Providing concussion discharge instructions to patients and families is part of routine standard of care. The objective of this study was to determine whether the use of the Acute Concussion Evaluation-Emergency Department Discharge Instructions (ACE-ED DI) improves the caregiver's knowledge of injury management, specifics about returning to school and sports activities, and outpatient follow-up. This was a quasi-experimental study conducted in an urban Level 1 trauma center pediatric emergency department (PED). A convenience sample of caregivers of children aged 5-18 years who presented to the PED with a concussion was recruited and consented to participate. Caregivers completed a 16-item survey to assess overall understanding of concussion management after instructions were given. Caregivers received the standard discharge instructions (SDIs) in Phase 1 and SDIs plus the ACE-ED DI in Phase 2. Descriptive statistics were used for demographic variables and t-test to compare groups. Sixty-three of 68 (93%) caregivers participated; 30 in the SDI group and 33 in the SDI plus ACE-ED DI group. Demographic characteristics were similar between groups. Caregivers who received the ACE-ED DI reported a 24% increase in helpfulness of written materials (p < 0.001), a 25% increase in perceived understanding about concussion injury and management (p < 0.001), a 23% increase in understanding about returning to school activities (p < 0.001), and were 17% more likely to follow up with their primary care provider (p < 0.001). The ACE-ED DI used in a PED was found to be more effective at increasing caregivers' perceived knowledge of concussion management, specifics about returning to school and sports activities, and outpatient follow-up.
小儿脑震荡很常见，许多儿童在急诊科就诊。向患者及其家属提供脑震荡出院指导是常规护理标准的一部分。本研究的目的是确定使用急性脑震荡评估-急诊科出院指导（ACE-ED DI）是否能提高护理人员对损伤管理的知识、关于重返学校和体育活动的具体信息以及门诊随访情况。这是一项在城市一级创伤中心儿科急诊科（PED）进行的准实验研究。招募了年龄在5至18岁、因脑震荡到PED就诊的儿童的护理人员作为便利样本，并征得他们同意参与研究。护理人员在接受指导后完成了一项包含16个项目的调查，以评估对脑震荡管理的总体理解。护理人员在第一阶段接受标准出院指导（SDIs），在第二阶段接受SDIs加ACE-ED DI。对人口统计学变量使用描述性统计，并用t检验比较各组。68名护理人员中有63名（93%）参与；SDI组30名，SDI加ACE-ED DI组33名。两组的人口统计学特征相似。接受ACE-ED DI的护理人员报告书面材料的帮助性提高了24%（p<0.001），对脑震荡损伤和管理的感知理解提高了25%（p<0.001），对重返学校活动的理解提高了23%（p<0.001），并且跟进其初级保健提供者的可能性增加了17%（p<0.001）。研究发现，在PED中使用的ACE-ED DI在提高护理人员对脑震荡管理的感知知识、关于重返学校和体育活动的具体信息以及门诊随访方面更有效。
