A critical evaluation of written discharge advice for people with mild traumatic brain injury: What should we be looking for?

Abstract

Objective: To formally evaluate the written discharge advice for people with mild traumatic brain injury (mTBI).

Methods: Eleven publications met the inclusion criteria: (1) intended for adults; (2) ≤two A4 pages; (3) published in English; (4) freely accessible; and (5) currently used (or suitable for use) in Australian hospital emergency departments or similar settings. Two independent raters evaluated the content and style of each publication against established standards. The readability of the publication, the diagnostic term(s) contained in it and a modified Patient Literature Usefulness Index (mPLUI) were also evaluated.

Results: The mean content score was 19.18 ± 8.53 (maximum = 31) and the mean style score was 6.8 ± 1.34 (maximum = 8). The mean Flesch-Kincaid reading ease score was 66.42 ± 4.3. The mean mPLUI score was 65.86 ± 14.97 (maximum = 100). Higher scores on these metrics indicate more desirable properties. Over 80% of the publications used mixed diagnostic terminology. One publication scored optimally on two of the four metrics and highly on the others.

Discussion: The content, style, readability and usefulness of written mTBI discharge advice was highly variable. The provision of written information to patients with mTBI is advised, but this variability in materials highlights the need for evaluation before distribution. Areas are identified to guide the improvement of written mTBI discharge advice.

• Acquired brain injury
• head injury
• mild traumatic brain injury
• neuropsychology
• neurocognitive disorder
• patient information
• post-concussion syndrome
• post-traumatic stress disorder

Acknowledgements

The Human Research Ethics Committee of Queensland University of Technology (QUT-HREC #1200000177) approved this research. QUT granted an occupational workplace health and safety clearance for this study. We wish to thank those people and organizations who provided project materials: Tom Peachey (University of Warwick, Coventry, UK) and the local hospitals that supplied discharge advice sheets for review. We acknowledge the contribution of Ms Hannah Blaine, who assisted with the cross-coding of materials, and Ms Catherine Haden, liaison librarian, who assisted with the citation of resources, and we thank the Motor Accidents Authority of NSW for permission to identify their material.

Notes

^†Note, this length criterion was arbitrary; it was selected to ensure that most materials were of similar length.

^†This advice is included in 2007 Clinical Practice Guidelines for the Initial Management of Head Injury. The 2008 version of the publication is based on material from these Guidelines [18].