Pictorial vs Standard Discharge Instructions for Burn Care After Discharge From the Emergency Department: A Pilot Randomized Trial and an Updated Systematic Review.

In 30 seconds

This paper reports a pilot, two-group parallel randomized controlled trial and an updated systematic review of pictorial versus standard discharge instructions for burn care. The trial enrolled 100 adults and children discharged from a single emergency department in Ireland and assessed recruitment, retention, comprehension, compliance, satisfaction, and reattendance. Across the review’s included trials, pictorial instructions were associated with improved comprehension (relative risk, 1.32; 95% CI, 1.10-1.57) and compliance (relative risk, 1.27; 95% CI, 1.00-1.62). The authors conclude that a larger trial is needed.

Key findings

• The updated review found improved comprehension with pictorial instructions (relative risk, 1.32; 95% CI, 1.10-1.57).
• Compliance also favored pictorial instructions (relative risk, 1.27; 95% CI, 1.00-1.62).
• Effects on satisfaction were uncertain (relative risk, 1.16; 95% CI, 0.72-1.87), as were effects on reattendance (mean difference, -0.29; 95% CI, -0.61 to 0.03).
• Recruitment of 100 participants to the single-centre pilot took 18 months, longer than anticipated, with seasonal variation identified.

Why it matters

Discharge instructions are intended to support care at home, and comprehension and compliance are relevant to whether patients can follow them. The review suggests pictorial formats may improve these outcomes, but estimates for satisfaction and reattendance remain uncertain. The pilot also highlights practical recruitment considerations for evaluating this approach in a larger emergency department trial.

What to keep in mind

The pilot was conducted at one emergency department and recruitment took longer than anticipated. The review’s estimates draw on a limited evidence base, and the authors identify the need for a larger randomized controlled trial.