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.