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When to Go to the Hospital

Comments [10]

Jeffrey Bazarian, MD, BrainLine


People like Natasha Richardson and others who've just had their brains jostled may be in no condition to decide if they need medical care. And the people around them may not know that hitting your head can be dangerous even if you don't lose consciousness. How do you know when you should go to the hospital after having "your bell rung"?


Going to the hospital after a head injury can mean the difference between life and death. But how do you know when to go? This can seem like a difficult decision, but let me sum up the answer for you: when in doubt, go to the hospital. Not later. Not tomorrow. Now!

Here's why.

The hospital is the only place that has a CAT scanner that can "look" inside your head and determine if there is any bleeding in your brain. Bleeding in the brain can be life-threatening when there is enough blood in the right spot to press down on the brain and squeeze it. These dangerous forms of bleeding are called epidural and subdural hematomas. Because the brain is trapped inside the skull, slow bleeding can force important parts of the brain against the inside of the skull and through the small hole in the base of the skull called the foramen magnum. These important brain areas, which control breathing and heart rate, stop working when they get squeezed and this is what results in death. With a CAT scan, epidural and subdural hematomas are easily diagnosed. The treatment requires surgery to remove the blood clot. The quicker the surgery, the better the chances for a good outcome.

So, how do you know when to go to the hospital? The decision is easy if you're the one making it for someone else and that person is not responding to you or looks asleep. This is called coma. The risk of a subdural or epidural hematoma in comatose head injured patients is high and you should summon an ambulance immediately!

But what if the head injury doesn't cause a coma? What if the head injury just causes a brief loss of consciousness, brief period of amnesia, or a sensation of feeling dazed? A person who has such an injury — termed concussion or mild traumatic brain injury — can look, and even feel, just fine. The problem is, even though the person looks good on the outside, inside the skull there is a small chance that slow bleeding is taking place. After a concussion, the chances of this happening are not large — about 1 in 1000 — but the only way to diagnose it is with that hospital-based CAT scan.

Here are the symptoms of a concussion that should prompt an immediate trip to the hospital or emergency department.

  • Loss of consciousness, even if only briefly
  • Any period of amnesia, or loss of memory for the event
  • Feeling dazed or confused
  • Headache
  • Vomiting
  • Seizure
  • In addition, for children under 2 years of age, any scalp swelling or abnormality in the way they usually behave.

One word of caution: because any brain injury — even a concussion — has the potential to injure the brain, the brain-injured patient may lack the judgment to make an informed decision regarding whether or not to go to the hospital. Family and friends can be instrumental in helping the patient chose a course of action that is best for him or her. And when in doubt, go to the hospital!


Click here to go to About Ask the Expert.

Jeffrey Bazarian, MDJeffrey Bazarian, MD, Dr. Bazarian is an emergency physician with a strong research interest in traumatic brain injury. He is associate professor of Emergency Medicine, Neurology, and Neurosurgery at the Center for Neural Development and Disease, University of Rochester Medical Center.

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Comments [10]

My brother was in a car accident and was expelled from the vehicle. His friends decided to move him and take him to the hospital. At the hospital they didnt do a CT he was just Laying in the bed conscious for a while until hours later he died :( reading this article I kew he had a brain hematoma and the negligence of the hospital is upsetting I'm boiling with anger inside. This article is very informative but my advice is if you fall wait on an ambulance unless your in danger -do not move and go to the hospital ASAP

Jul 5th, 2015 9:15pm

My girlfriend got a concussion because she is very clumsy and can't stop hitting it. She has hit her head more than 20 times after that (about 10 of them were really hard). Now she feels nauseated all the time, has a major squeezing headache, chest pains and hard time breathing. We went to the hospital twice and she was supposed to go do an MRI. But its been a month and they haven't done anything for her yet. Please help. 

Jun 5th, 2015 9:48pm

I had gotten hit in the back of the head while playing basketball afterschool. I was at home and probably 6-8 hours later my head still really hurt and I experienced symptoms of Headache, Feeling dazed, confused and nausea. Turned out I had a concussion, this really helped.

Jun 2nd, 2015 7:33pm

I had a fall from a roof and hit the terrace on the floor below pretty hard, I did not suffer any broken limbs but bruised the top of my head badly. I went to Hospital and received first aid, I did not loose consciousness and after having a CAT scan at the Hospital which only revealed 2 small hairline fractures with no displacement I decided to go home with the agreement of the Doctor as I could not bear to wait in the Hospital corridors any longer for further investigations/assessment (I had been hanging around for 6 hours). At home I spent a very scary week as in the middle of the night I developed what I found out to be BPPV which scared the hell out of me, however it all gradually cleared (it took a week) and I am 99% recovered, 5 weeks after the occurrence. I am extremely grateful for the information I was able to obtain from the internet but not so happy about my experience in a crowded A & E department.

May 9th, 2015 12:54pm

My father in-law died one week after falling against an end table. He had a brain bleed. Lost speech and movement in his body about 3 days after fall.

Mar 31st, 2015 2:45am

If you hit your head, are hit or fall go to hospital & get checked or see a Gp ( I am in London Uk) to get it checked out & recorded and keep a log. You can develop post concussion syndrome or traumatic brain injury which I now have after 2/3 knocks to brain. Join the pcs group on facebook or set one up, look up bloggers, I find helpful, I tripped on a cloth & hit my head at a clients but thought nothing of it. Few weeks later cat knocked stereo on my head. Felt very ill since. In UK- NO treatment!! Thankfully am a yoga therapist & mindfulness teacher/therapist so def recommend that- mindful breathing, but this is awful. Am using lavender oil all over my head with water which helps, lavender baths, & will try acupuncture. Wish you well recovering. Take care blessings & namaste Nathalie

Jul 23rd, 2014 7:22am

It is very important that you go to a hospital when you hit your head. I collided with a player in a soccer game recently and I thought I was fine. But my parents and coach convinced me to go to get it checked out. It turns out I had a pretty bad concussion and I was out of everything for 2 1/2 months. If I wouldn't have gone symptoms could have gotten worse and I could have gone into a coma. Moral of the story is to always go to the hospital or doctor when it's a head injury because it can't hurt even if nothing's wrong.

Apr 15th, 2014 7:39pm

This is THE article on the internet that convinced my very stubborn husband to go to the emergency room.  He fell on the ice, suffering a concussion with the associated amnesia.  He refused to go to the ER for a CT scan for over 24 hours, until I showed him this article.  Fortunately, he did not have a brain bleed, which is the reassurance I so desperately needed.  Thank you!

Feb 17th, 2014 2:50pm

Wow this helped alot. My 8 year old daughter was playing basketball and fell on the cement and this info helped me perfectly!!! :)

Dec 20th, 2012 3:02pm

Thank you for your helpful information on head injuries, my mother fell hitting her head full on the concrete floor. We were not so sure if she should go to the hospital or not, looking it up on the web we found this website, which answered all of our questions right away! We now all know that the best thing to do is get information from some one who works at a hospital, so my mom called a nurse for her opinion; the nurse told my mom that it is not as bad as she thinks. -thanks again!

Mar 12th, 2011 1:39pm

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