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

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

My 2 year old sister hit her head when she fell off the trampoline from about 1-3 feet. I'm wondering if this would cause any brain damage?

I hit my head last month on a table at school and my head was hurting. I just sucked it up and went about my day. A few hours later my headache got extremely bad. The school called my mom and I passed out in the car, then my neck became stiff. When I got to the hospital they tried talking to me but my words where slurred and the hospital gave me ibuprofen. They sent me home and the next day my headaches got worse and I was throwing up so my mom scheduled an appointment with my PCP where they told me I could have a concussion so I was referred to a head first clinic where they specialized in injuries to the head and i took an impact test. My balance and my vision was off and my test score was really low. I was put on rest for another week. On one of my "rest days" I was passed out and I hit my head again. On Monday I had my checkup with my concussion doctor where I re-took the impact test and i scored worse. My balance was off and worst of all my blood pressure was 136/88 and I'm 14. That same day I was scheduled to see a neurologist where they did a CT scan and it's been 1 month and no recovery I'm currently waiting on my results and have to return tomorrow.

Thanks. Your words of advice and clear explanation helped me make a decision. Blessings!

I was in caye Caulker Belize when I fell down two steps on concrete floor. I was lifted up by two men and escorted to my vacation cottage. I started to vomit and had some trickles of blood from my nose. I was put to bed because there was not a dr on the island. I laid the next day as well and had to catch a plane back to the USA. I went to the ER the following day and a cat scan was done and drs determine I had a brain bleed. Was not allowed to go home. Was put on some meds and release the next day. It has been over a week and I still am very dizzy when I get up from a sitting or lying potion. I can hear very well from one ear. A scary thought that this can happen to anyone and being in a third world country really is scary time to have a brain bleed. It can take up to 6 mo to 2 years to clear.

This helped me a lot thnx

Thank you for the concise article.  It gave me exactly what I needed to know after I was knocked over and sent flying by one of my horses, landing on my back and crashing my head on the ground.  I was dazed but did not lose consciousness, but had a headache and was dizzy and sleepy the rest of the day.  The next day my headache got much worse and then I started vomiting.  Still I wasn't sure if I really needed to be checked out at a hospital as I wasn't sure what they could actually do for me if it was a concussion,  or what the risks were.  That's when I found this article and learned about the danger of a brain bleed and that a CT scan should be done to check for that.  That decided it for me,  even though no one likes a trip to the ER and all the waiting you typically have to do there.  (Fortunately in my country - Canada - there was no cost to me, which I admit makes the decision a lot easier).  They did a CT scan and gave me pain and anti-nausea medication through an IV.  Thankfully my scan came back normal,  but I am still glad I took the advice of this article and got checked.  I would urge anyone who has a head trauma  to do the same.  All you have to do is read some of these comments to see the dire and sad consequences that can and have occurred if you don't.

This really helps thank you

Eleven years ago, fell at work, passed out a few minutes and then a passed out again, fifteen minutes later and didn't remember the incident. While passed out during in second time, two managers came upon me, thought I was sleeping, could not rouse me, so just waited for me to regain consciousness. Didn't think to call Reedy Creek fire department for me. They suspended me, let me go to drive home in a daze. Next day, my friend tells me l probably have a concussion. So called work. Went to company first aid, they sent me to hospital Celebration in Florida...and then told me hours later.. Nothing was wrong with me. But I knew I wasn't right in the head..math skills screwed up, missing huge chunks of memory to this day. Oh, got fired too. So I learned not to trust big hospitals.

I fell flat on my face and banging my head above my right eye about 4 weeks ago, I have had a bad headache since and I'm feeling drained and can't be bothered to do anything, I'm normally an active lady but all I want to do is sleep and be left alone. I do feel a little sick sometimes. I don't want to go to hospital because I know they won't give me a cat scan because I had a bad fall years ago and they said I had trauma to my brain and it would settle. what should I I do about this injury?

I was taken to the emergency room in an ambulance after falling and hitting my head hard. My forehead above my right eye was bleeding, but I got no attention from the hospital, even to apply antiseptic and bandage the area.  With all the more serious illnesses and injuries continually pouring in, I was never seen for a ct scan or anything else. I had to go to urgent care the next morning and they didn't even have a ct scanner. 

I hit the front of my head on a metal merry-go-round when i was about six years old. I lost consciousness, but my grandmother just took me home. I was out cold for two days. My grandmother said i came back different. Maybe so, but no violent or antisocial behaviors. Still hit my head occasionally, but go to doctor every time.

Cat scans are very expensive. I had one a few years ago after I closed a trunk bike rack on my head at full speed, and I had insurance back then, but I saw the bill what it would have been without insurance and it was $4500. It's probably even more now.

I don't have health insurance so I might not go to the doctor it sounds expensive to receive a cat scan

I was in a car accident and I'm having confusion blurred vision loss of balance have fallen twice since, have gone to the ER twice, once had a CT of the skull of the brain and it showed no brain bleed. Could I still have a concussion or concussion syndrome?

Anytime you fall or hit your head (NO MATTER WHAT), even if its a light fall, you should take yourself or the victim to hospital. A simple cat scan can save a live. Most people die from falling because of brain injuries that go untreated . Be proactive.

On Monday (today is Thursday) I hit my head not hard on a brick wall. I have been feeling light headed when I get up ever since I did not go to a hospital because I was in no pain what should I do? I am still light headed when I get up.

I bumped my head really hard while getting out of the car. It's going to go be week on Sunday. I keep getting headaches were I hit my head. Is that normal?

I fell on the ice this morning, hit my head and back so hard, what should I do? Any help

You are absolutely correct about those around you needing to take some control about steering you to hospital. I collided with a piece of solid equipment at work with a bleeding scalp and seeing stars. No one suggested I see the ER docs even though this happened in the OR. 48hrs later with a bad headache and 'not feeling right' I attended the ER but had to accept the UK NICE guidance and so no scan was done. I was not able to be as forthright as I would normally be and, as my husband is not medical, he could not do it on my behalf. Few weeks later a skull fracture was diagnosed with a leak of CSF. I am a doctor. 

To the person who said there is nothing anyone can do -- yes, there is. My mom, at 83 years of age, had brain surgery not once, but twice to relieve pressure from bleeding. Five years later, she's still doing great. 

To the person below me: the article literally says that surgery can correct the problem. Not sure why you think that there's nothing anyone can do.

Even if there's a bleed-which is basically the only thing a CT will show-there is nothing to do in most cases. Peace of mind at best...

My daughter was hit in the head multiple times playing water polo.  It wasn't until a week later we took her to the Dr because each day it was something different - she couldn't concentrate, then her eyesight, balance, talking. Today the Dr referred her to a neurologist and an MRI.  Hopefully we get answers. 

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

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. 

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.

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.

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.

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

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.

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!

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

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