INAPPROPRIATE DISCHARGE INSTRUCTIONS FOR YOUTH ATHLETES HOSPITALIZED FOR CONCUSSION

Objective. To evaluate the medical care, especially the discharge inst ructions regarding return to participation, received by youth athletes hospitalized for a closed head injury. Methods. We examined the recor ds of all patients admitted over a 5-year period (1987 through 1991) t o The Children's Hospital of Alabama for a sports-related closed head injury. Descriptive information was recorded and discharge instruction s reviewed. Injury severity was graded according to guidelines current during the study period, as well as those outlined most recently by t he Colorado Medical Society, which have been endorsed by a number of o rganizations including the American Academy of pediatrics. Discharge i nstructions recorded for each patient were then compared with those re commended in the guidelines. Results. We identified 33 patients with s ports-related closed head injuries. Grade 1 concussions (least severe) occurred in 8 patients (24.2%), grade 2 in 10 (30.3%), and grade 3 (m ost severe) in 15 (45.4%). Overall, discharge instructions were approp riate for only 10 patients (30.3%), including all with grade I concuss ions, but only 2 with a grade 2 (20.0%) and none with a grade 3 concus sion. Conclusion. All who care for youth athletes must become familiar with the guidelines for management of concussion to provide appropria te care and counseling and to avoid a tragic outcome.