Ankle sprain discharge instructions from the emergency department.

OBJECTIVES: (1) To describe the incidence of inclusion of early mobilization components in emergency department (ED) discharge instructions; (2) to describe the prescribed follow-up appointments; and (3) to analyze the differences between the treatment of pediatric and adult patients.
METHODS: A 1-year retrospective chart review of ED records of a large urban hospital was performed. Medical records of 374 (95%) of the 397 adult and pediatric patients with ICD-9 code for ankle sprains were reviewed (213 males and 171 females, mean age 28.4 +/- 14.5; 291 adults, 93 pediatric).
RESULTS: Sixteen percent of records contained discharge instructions that included rest, ice, compression, elevation, and medications (RICEM). Twenty percent included RICE. Pediatricians (33.7%) were more likely than adult physicians (10.3%) to have given RICEM (P < 0.0001) and RICE (P = 0.05, pedi = 45.8%, adult = 13.1%). Follow-up referrals were recommended as needed 50% of the time. Follow-up referrals were made to community clinics (59%), orthopedic clinic (23%), the ED (14%), and others (4%). Pediatricians were more likely to recommend routine scheduled follow up (pedi = 62%, adult = 47%, P = 0.018), suggest follow-up in a community clinic or doctors office (pedi = 68.6%, adult = 51.2%, P < 0.0001), and to recommend earlier follow up (pedi = 1.6 weeks +/- 1.1, adult = 2.0 weeks +/- 1.1, P = 0.002) than adult physicians.
CONCLUSIONS: Programs that train physicians who work in the ED need to include education on the proper treatment, rehabilitation, and follow up of patients with acute ankle sprains. Providing easy-to-complete discharge instruction templates can help providers give patients discharge instructions that may help patients minimize the risk of long-term sequelae.