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Is It True That You Should Keep Someone Awake Who Has Sustained a TBI?

Comments [5]

Jeffrey Bazarian, MD, BrainLine

Is It True That You Should Keep Someone Awake Who Has Sustained a TBI?

I always learned that if someone got “dinged” that he should be kept awake.

How long should someone be observed after receiving a mild brain injury and is there a time frame for the person to stay awake?


There is no benefit to keeping someone awake after a concussion, and it is no longer recommended. In fact, people with a concussion need to sleep to recover. In the days before head CT scanning was widely available, the only way to know if someone had life-threatening brain bleeding (which occurs in less than 0.1 percent of those with concussion) was to observe him for a decrease in his level of alertness that resulted from the blood pressing on vital brain structures. This usually happened within six hours of injury. It was thought that if you could keep someone awake you could prevent him from lapsing into coma, which of course did not work.

Anyone getting very sleepy within six hours of a brain injury should be brought immediately to an emergency department for a head CT scan.

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 [5]

I went to ER. The only thing they did was address all the cuts on my face! It was weeks before a CT was done! A year later things got very crazy for us when a MRI was done and they could see the damage!! This also was done at another Hospital!! So don't just say "ok" if you feel something is wrong!! If you see changes in the person after the fall keep looking for the "why"!!

May 23rd, 2016 10:48pm

If someone just wrecked on a bike, fell when they were playing, or just had a big spill and hit their head, it hurts and scares them to the point their adrenaline level spikes very high. I've noticed when someone is scared to the point of crying in a traumatic incident they tend to fall asleep soon after they come down from that adrenaline rush. Couldn't this be the reason why someone might fall asleep soon after they experience a hit to the head during a somewhat traumatic experience and not just the hit to the head?

May 15th, 2016 8:27pm

You obviously won't know if they sustained a "brain injury" as you can't directly see the brain (hopefully!). To state what he said another way, "within six hours of a head injury". The terms head injury and traumatic brain injury are often used interchangeably as somebody who sustains a good-sized head injury will often have a brain injury as well. However, "brain injuries" present on a wide spectrum from "really no injury at all" to "concussions" to "brain bleeds". That being said, not everybody who gets knocked in the noggin needs to be evaluated in an emergency department. Concussions in and of themselves are NOT life-threatening, and no treatment is needed (other than rest). However, one cannot tell if the patient has a more serious brain injury (such as a bleed). This is why it is important to pay attention to symptoms. Somebody who becomes very lethargic, difficult to arouse or awaken, may have a severe concussion, but more seriously, may have a brain bleed. A CAT scan is the only way to tell. Symptoms to worry about: excessive vomiting, significant confusion, lethargy, inability to stay awake or awaken, significant difference in pupil size, numbness/tingling or muscle weakness on one side.

Dec 15th, 2015 4:17pm

Yes. Anyone who has had a tbi should go the the emergency room right away

Oct 2nd, 2015 6:10am

In your article you said anyone getting very sleepy within six hours of a brain injury should be brought to the hospital for a CAT scan immediately. Maybe I don't understand the term brain injury. How would I determine the person had a brain injury? Shouldn't anyone sustaining a hard blow to the head be checked at a hospital?

Sep 3rd, 2015 11:30am

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