When to Go to the Hospital

Question: 

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"?

Answer: 

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!

Posted on BrainLine April 8, 2009. Reviewed July 25, 2018.

Jeffrey Bazarian

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.

Comments (232)

My ex beat me pretty bad in late March. I had a knot above my temple. Was dizzy, nauseous n couldn't get myself together for over a week. Now today I'm so dizzy I am walking like a drunk. Could it be as a result of my beating

I was playing on the floor with my grandsons yesterday. I was laying on my stomach, and the 2 1/2 year old climbed on my back and was standing. Next thing I know, he jumped up then landed on his butt... on the back of my head / neck. I heard a "crack", and my face hit the floor (with glasses on). I screamed. Took me a minute to get up. I was pretty sure the rest of the night. Woke up this morning with the pain in the back of my head being worse... don't know if I need to go see a dr or not?? Or just wait it out.

Hi, I fell and banged my head on wall 5 days ago. I didn't know I did it until I woke up the next day. My head was bruised and small cut. I bathed and it's ok but have a minor headache and bruising. Is this normal after 5 days to still have a headache?

So back in 2011 I remember being in the Marines and getting drunk one night. I woke up with the worse headache ever and I thought it was a hangover because I've never gotten one I thought it had finally happened.

My buddies tell me that I slammed my head against the metal door in our room because I was too drunk and opened it way to hard and fast. Now I don't remember any of it or even when we started drinking.

But I remember the day after I had the worst headache, I was dizzy, and felt nauseous all day. I'm wondering would that have any long lasting effect? Because I never went to see a medic and within 2 days I finally felt better.

A thing I've noticed though is I have random times of slurred speach and can't for the life of me remember people's names. But I can't tell where my PTSD begins and the brain damage ends.

Should I still get a CAT scan from the VA or is the damage done and I missed my opportunity?

What is it called when hit head twice. 1st in front & then back

Whip lash ? Forward and backwards movement of the head . Like when your in a car accident or for small children "shaken baby syndrome"

I was going out to my car last Friday. I fell in the parking lot and landed on pavement on the left side of my head. I was unconscious for 2-3 mins. They said when I came too the were trying to get me in the car to take me home. I got very combative and vomited. I’ve never been combative. They took me home my roommate who has known me for years said I had garbled speech. My boyfriend who took me home and was mad at me. Thought I was drunk and acting this way. My roommate then said I started walking down the the middle of the street. He came up asked me where I was going. Well, he also thought I was just drunk. He took me home I slept until Sunday. Got up head hurt really bad and I had a huge knot on the left side of my head. Finally my head hurt so bad on that side, my vision was blurry, I couldn’t find words when trying to talk. When I went to the ER I’m black behind my ear all the way up the almost the top of my head and it’s huge. The nurse and Dr was lifting my hair up to see how big the black area was. They sent me to a CT stat. They came back to tell me I had 2 blood vessels that slow leaked luckily sealed and I had a lot of blood on that side. Told me that I had moderate Traumatic Brain Injury with hemorrhaging and a concussion. Told me that I was lucky to still be alive. Since then I have done nothing but sleep. My boyfriend of 9 1/2 months broke up with me and was listening to all the people saying I was crazy because I was so combative. I let him know about what the Er said. But, he just said he did know what too say but he was done with this. I didn’t even doing anything. But, my question with a head injury like I have was I combative because of the injury when I came too? I can’t remember anything

I had a small head injury and as well as injury on my forehead and got unconscious. It was due to a motorcycle accident. After the incident I had severe head aches for 3 days now from the time the accident happen and also scenarios of vomiting. What should I do?

Hi, I fell backwards while trying to get in the backseat of our rental car. My foot got nammed and I went down hard and hit the back of my head on the pavement. Got a large lump, applied ice and went to ER in the morning. Had CT scan, said no bleeding but why a week later not getting better. Really hurts and having bad migraines?

Just takes time to heal. Give it a few more days and if it's still not getting any better then I would go see my primary care doctor.

I was hit in the head by a candle weighing about 3 pounds, which fell off the cabinet, I am now experiencing headache, ear ringing and blurred vision I also have a knot the size of a silver dollar. Should I go to the doctor?

Yes you definitely should.

Yes you for sure should get seen.

Thank you for this very important information. I fell off a chair today and hit my head. I went to the hospital immediately after reading this. Fortunately I only required two stitches, and the CT scan was clear. I will be monitored over the next two days by the doctor, and I will have the staples removed in 7 to 10 days.

Today at school i was hit with a basketball pretty hard then my head started to hurt really bad and i dont know if i should go to the hospital and right now it kind of hurts.Also i got hit on the side of my HARD

1yr old son fell backwards and hit head on tile floor. Vomited 2x before bed. Brought to ER for CT scan. All clear. Came home with high fever of 101.4-103.1 every 4hrs. ER said they did a temporal thermometer check and it was 99.5. I did rectal thermometer check and it was 101.4-103.1... Child continues to vommit every time awake after nursing. Son very lethargic and not usual self. What to look out for? What is happening if CT scan says all clear.

Go to another doctor if you have not already! You know your child best.

I really hope you got a second opinion. Dizziness in toddlers and/or vomiting, something isn’t right. Him being Lethargic isn’t good either

Hi I husband rolled his tractor feb 14, 2013. It’s been 5 years 7 months and I don’t know what is wrong with him. He’s not his self this all started in the last year and getting worse. He won’t help with anything around our house I have to pay someone to come help me. Yesturday was our 28th anniversary and he never said anything to me and he knew it was. I set and cry a lot because I don’t know what to do to help him.

When i was in school my friend pulled my chair out from under me when i tried to sit on it and i hit the back of my head hard on the table behind me. As soon as i hit my head everything went black and i couldnt remeber falling just what happened before i hit my head and for the rest of the lesson i felt weird like a mix between sick and confused. This happened a few months ago what should i do?

i wouldn't even consider him as a friend. geez

My friend shoved me and I fell back and hit the top left side of my forehead on the door. I don’t feel dizzy or have a headache I just have a bump on the side of my head

I know someone that was it in the hit from a basketball and suffered from a concussion, and after that cleared up she is now complaining of vertigo and dizziness. Is the vertigo real? Can you be suffering from Post-concussion syndrome? None of the search state that vertigo was a result of a concussion, unless it was preexisting and the basketball just dislodged the crystals in the inner ear? As you can tell I have a few theories. What's your take on this?

My husband had way too much to drink in our above ground pool 3 days ago. I was called back to the pool by a friend of ours who found him briefly floating face down in the pool. He is 6.5 tall and 111kilos. We managed to eventually get him over the side, when he first hit his head. After he came around we managed to get him up and start walking to the house. He then feel back pulling me with him, which in turn made our heads hit. Since then he has had trouble sleeping, constant ringing in his head and just a general feeling of unwell. Should I be considered or make him go to hospital?

I had a seizure about 4 days ago and was brought to the hospital, they did a CAT scan and a X ray to make sure everything was fine as I fell face first on my right side. Now when I wake up in the morning the right side of my head feels a very light pain, is this something I should get re checked or is this normal?

I had a craniotomy 3 weeks ago. My stitches are removed and it’s about a 4 inch long incision from the base of my scalp toward the middle, top section. Overall doing good except for pain, headaches, and light headedness here and there. I haven’t been taking pain killers because I can tolerate it for the most part. The issue is, I hit the back of my head pretty hard today. I hit it right above my incision where I’m missing part of my sub-occipital. It feels bruised and tender. I didn’t loose consciousness. I was out of it for a bit but fine after 5 min. I hit it inside the car where the passenger window and actual door meet by the seat belt. No bleeding but I have been feeling dizzy with major headaches. It was okay when it happened but after about 7 hours, it’s becoming very bad. Like I can’t focus on typing because it hurts my head more. Still monitoring it but not sure if I should go I’m or not.

My husband fell in the hospital when brought to the rest room. He had an O2 sat of 83 and they walked him to the rest room. After hitting his head they had to do a sternum rub to wake him. Brought back to the ER room and developed a huge hematoma on his cheek and a black bruise on the inside of his ear. They did a CT scan without contrast and it showed nothing. The next day he had a seizure and died. Is it true that a CT scan could have missed a slow bleeding vein?

That's awful i'm sorry to hear that happened. If I was you I would talk to a malpractice lawyer and have them get there doctors to look at the ct scan results. They would know best on how to assist you.

You need to seek an attorney ASAP! This is a classic case of negligence and medical malpractice. Make sure you get an attorney that specializes in medical malpractice.

I hit my head pretty hard 2 years ago I hit the back of my head and became blind for a few seconds I didnt tell anybody because I was working and I realized I couldn't concentrate or remember new information and I cant think clearly should I go to the hospital or is it to late?

GO TO THE HOSPITAL! They can still see what's going on and try to help

When I was on my way to work I did not notice the car parking barricade lifted up n I moved on. It fell on my right side head very badly n bounced back. I got a very bad bump but I'm feeling better. Though everything seems better my vision is slightly blurred. I have not been to the doctor. It's been 3 days since the incident has happened n I'm a little scared. What should I do now.is it going to create a problem later?

Still go in to get checked.

I had a head collision to my right side three years ago. I cannot feel for it for about 30 seconds. There was a 1 min stomach pain and blurred vision for a few days.

I have gone to the hospital. The doctor gave me ibuprofen and told me to come back if the pain does not go.

I don't took that medication but pain gone after 2 days. I was good and good now too, but I feel difficulty breathing sometimes and can feel the heartbeat in my head while sleeping. What can I do now? Please help me.

Tell your doctor if it's still happening.

I hit the base of my skull on a metal bar while playing on the jungle gym. After I hit my head I lost grip of the monkey bars and coincidently fell. When I stood up, my vision was blurry and I saw “stars”. In addition to having troubled vision, I was dizzy. This event occurred 5 hours ago and still have a bad headache. I’m frustrated as hitting my head was highly avoidable and I don’t want to suffer from any permanent brain injuries or complications. My memory also seems duller. For instance, I had to review my spelling serval times and I don’t usually struggle with orthography. I’m 15 years old.

Thanks for reading this and apologies for rambling.

I experienced a sub cranial brain hemorrhage, concussion and seizure after a motorcycle accident, and a week and a half later I’m getting headaches that sort of pulse in the back of my head. Should I go to the ER? I have a follow up appointment with a neuro surgeon on Monday, but should I wait?

I was getting some groceries out my trunk and the trunk flew back and hit the front of my head causing a lil dizziness and a dent in my skull. I feel a lil tingling all over my body and i am drowsy. What should i do?

My brother hit his head pretty good on the pool floor when my niece and nephew were playing on top of him. Almost immediately he said he couldn't see very well out of his left eye but could see fine out of his right. We let him sit for a few minutes and was uncomfortable with the bright sun. It took two of us to stand him up. He is rather large at 6 ft 2 and he was unbalanced. He vomited a little bit so we laid him on the pool chair in the shade. He has had concussions before playing football. He has a good red mark where he hit. He hasn't slept for the past 12 hours so it doesn't set in. But how can i be sure it's only a concussion? There is a difference between getting your head knocked around wearing a padded helmet and getting it hit without one. How can i be sure it's not a bleed because he is unwilling to go to the hospital. He thinks we are overreacting.

It totally sounds like a concussion- hope he went in :(

I fell and hit my head. On a granite counter and subsequently the tile floor, I did not lose consciousness but raised several large bumps on my head. Treated with ice packs for two to three hours. Slept, but not well, and have a mild headache this morning. Should I go to an emergency room?

I fell and hit the concrete floor hard in April. I went to the ER got X-ray's and CAT scan. The Dr said I had a concussion and contusions to my back and pelvis. My head hurts so bad every day I wake up with anxiety and can't get back to sleep. I feel my vision going blurry on off throughout the day my ears ring and ache at times with migraines that show up when I turn my head or just move it.
My memory is shot I now write important things down because I can't remember the simplest things like meeting someone then leaving The room when I get back I've already forgotten their name or that we already met. This is depressing and as for the back pain it's chronic and always a combination of neck and shoulders lower back and hips. It hurts to drive walk and sit. I can't lay down on my back anymore because the injury on my head pushes pressure to the crown of my head and I can't lay on my stomach due to the pain it puts on my hips and pulling twisting pressure on my brain. I've been back to the ER twice and they said that I hit my head really hard and rattled my brain. The Dr called the neurologist who said my Dr first needed to get a MRI done before she would see me. However my insurance won't cover it because they don't see it as medically necessary.
But I'm always in pain now and something is wrong with my brain

Has anyone experienced a delayed concussion? I had a car accident almost 3 weeks ago. I didn’t think I lost consciousness when it happened but there is a blank in my memory between hearing the glass shatter and realizing the airbag was burning and the car was full of smoke. I thought I had a full account of the events after the wreck but a week later I saw 5 people who had stopped to help and I didn’t remember or I felt like I’d never seen them. in the last week I’ve had a headache in one spot and short term memory issues. I realize at the time I could have just been in shock and now could just be really anxious about it (finding out what I thought happened after and what did happen was pretty upsetting).
Does this sound familiar to anyone and if so, can you share? ....thank you!

Yes. This happened to me during a car accident as well... my scenario was that I remembered the impact and looking at my injuries -my legs- and what was going on around me but I couldn’t remember being carried out of the vehicle and being placed along side the road where the accident happened. I was told that I passed out from the truma. That could possibly be what happened with you. You blacked out from shock.

In Aug. 2017, I hit my head on the concrete steps at church. Both preachers were there and asked if I was alright. I said yes & went home. However, later that year I started developing horrible headaches. Finally on April 30, 2017, I started walking to the right and my head hurt so bad I wanted to take it off. I went to the ER with blue fingertips, pale skin, my mouth was pulled down on one side and I didn’t know who the President was. A CT scan was done and I was told I had bleeding in the right side of my brain. I was taken to San Antonio by ambulance. There I had an MRA but they didnt fun anything. I was told the blood was old blood. The next day, I was about to be released when I saw 2 clocks on the wall, then I saw many clocks on the wall and worms on the bathroom floor - but an EEG found nothing. Once I came home I started stuttering. Can you tell me what is going on?

Hey uh I was playing basketball and I got hit in the face by a rebounding ball. I felt perfectly fine afterward when I went to work out and go swimming. Now after about 10 minutes of me being home and resting, my body feels really heavy, I'm feeling kinda nauseous but not much, I've got a headache, and I'm having difficulty focusing on more than one thing at a time, like only the words in a commercial and not the video too. I just missed my chance to go get it checked out-should I have gone? I don't think I have a concussion but I want to be safe so my gf doesn't worry

Today I was running wire in a new construction building I stood up straight into a metal beam. I sat back down. It hurt and burned all across the top of my head. My ears hurt, the base of my skull, neck and shoulders. I went to a chiropractor within 2 hours of doing this. He said I definitely injured my neck and I’ll be more stiff and sore in the morning. It’s now 5 hours since I hit my head. I’m very sleepy. I normally don’t get sleepy this time of day even after working like that. My head feels funny and heavy. Eyes are blurry and pain off and on in my head behind one of my eyes, etc. My neck still hurts of course. I didn’t think I had a concussion, but now I’m wondering. Should I go to the doctor? I just want to go to bed... although I wouldn’t normally go to bed for 5 or 6 hours from now.

Something similar happen to me 3yrs ago and I think I'm losing hair bc of it ! I jumped and top of my head hit short ceiling.

My son felled and hit the back of his head. Started to complain of a headache 2 hours later should I take him to the ER

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