The discharge instructions received by youth athletes hospitalized for a sports-related closed head injury over a 5-year period (1987-1991) were examined at the Children’s Hospital and University of Alabama, Birmingham, AL. Injury severity was graded according to Cantu’s 1986 guidelines and compared to the Colorado Medical Society guidelines as endorsed by the American Academy of Pediatrics. Concussions were grade 1 (least severe) in 8 patients (24%), grade 2 in 10 (30%), and grade 3 (most severe) in 15 (45%). Discharge instructions were inappropriate and not in compliance with guidelines in 8 of 10 patients with grade 2, and in all of 15 with grade 3 concussions. The majority had uneventful hospital courses, but most received inadequate counseling regarding potential future risk. Of 23 for whom instructions were inadequate, 3 were allowed to return to sports participation too quickly, and no instructions were documented for 20 (87%) patients. [1]
COMMENT. Lack of familiarity with guidelines for the management of concussion in sports-related head injuries was one explanation for the frequency of inappropriate discharge instructions. The Colorado Medical Society guidelines are summarized as follows:
• Grade 1. Confusion without amnesia or loss of consciousness. Return to sport permitted after 20 minutes, if no symptoms at rest or on exertion.
• Grade 2. Confusion with amnesia but no loss of consciousness. Observe 24 hours. Return permitted after 1 week without symptoms.
• Grade 3. Any loss of consciousness. Admit if neuro exam abnormal. Return permitted after 1 month, if asymptomatic for past 2 weeks.
Football accounted for 55%, baseball 12%, soccer 6%, and wrestling 3% of injuries in the above study. Documentation of discharge instructions is important for medico-legal reasons.