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

INTRODUCTION: Individuals presenting to the emergency department are often discharged home with instructions on how to manage their condition. Previous research suggests that pictorially enhanced instructions may offer benefits, but the evidence seems limited. Thus, a pilot randomized controlled trial to inform a future larger randomized controlled trial and an updated systematic review were performed. METHODS: The pilot was a 2-group, parallel randomized controlled trial that compared pictorially enhanced and standard discharge instructions in 100 adults and children presenting with burns to a single-center emergency department in Ireland. Recruitment and retention processes and participant comprehension, compliance, satisfaction, and reattendance were assessed. Descriptive statistics, relative risks, and 95% CIs were used to analyze the data. The systematic review update, with searches to July 2025, emulated the methods of the original review. RESULTS: Recruitment to the pilot took 18 months, a longer duration than anticipated, and identified seasonal variation. The updated systematic review, including data from the pilot and 2 newly identified randomized controlled trials, found positive effects on improving comprehension (relative risk, 1.32; 95% CI, 1.10-1.57), compliance (relative risk, 1.27; 95% CI, 1.00-1.62), and satisfaction (relative risk, 1.16; 95% CI, 0.72-1.87) and reducing reattendance (mean difference, -0.29; 95% CI, -0.61 to 0.03). DISCUSSION: The pilot randomized controlled trial highlights important factors to consider when designing and implementing a future randomized controlled trial. The updated systematic review validates the need for a future larger randomized controlled trial to expand the evidence base on the use of pictorial discharge instructions in the emergency department.