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 (148)

My son was diagnosed with Spastic Paraplegia #20 complex. age 36 diag/3 years ago. He told me he has fallen many times due to balance issues. For the first time today I saw him fall and bang his head on the cement driveway. He stayed cleared headed, as for some assistance, but got up and said he was not feeling sick . Refused to go to ER. My concern is with leisions on his brain, could this make him more apt to get a bleeding in his brain as his brain is shrinking as well.

I banged my head last Wednesday and the headaches are never ending. My head feels so heavy and my eye hurts on the side I hit but my vision is fine

Hey i had gotten up out of my gamer chair really fast after did that i got really light headed and blacked out. I hit my head on the door and a metal candle lid. When i regained conceness a few minutes after my whole body was tingling. Now i just get migrains, feel nausios, feel depressed, having a hard time sleeping, and feeling drowsy all the time. Should i go to the hospital or no??

I know the article said to go to the hospital if there was any doubt but I just really want a second opinion right now because it's 9:30 PM where I live and I don't want to have to make my parents go out if they don't have to. At dance practice today, I was practicing a certain acrobatic trick and we didn't communicate well enough so I was dropped extremely hard on my left cheekbone and still very hard on my lower right side of the back of my head. Initially, I felt extremely dazed, my vision became dark and spotty in certain places, especially the edges, my head hurt on the location of impact (obviously), and I just wanted to close my eyes and not move. This went on for about five minutes and after this, I just felt out of it and a little dizzy, but I continued practicing (with a lower intensity of course) after my dance coach checked my pupils to make sure they were dilating properly. This happened at about 6 PM and I continued to feel better until now because I just feel very anxious and still out of it and I don't know what to do. I don't know if I'm just shaken up by what happened and now I'm overthinking it, but now I'm just scared and I need opinions. Please help me.
On Sat. 4/7/18, I slipped on ice and fell backward, landed on my back and hit the back of my head really hard. I was a little disoriented at first, but just for a minute or so. I worked the rest of the day and had a Dr.s appt on Mon.4/9/18. My Dr. asked me if I vomited and if I had a headache. I said no, but I didn't mention that I have been sick to my stomach, but have also been going through a lot of stress. The Dr. said I had a hematoma and it would heal on its own. Since I'm sick to my stomach should I go to ER & get brain/skull scan? It smacked the concrete extremely hard, I couldn't believe that when I reached to the back of my head there was no blood. Should I be worried being its been 3 1/2 days now? I still haven't had a headache. Only sick to my stomach, but think...I was before this happened? My family Dr. is pretty smart, he has even given and read my stress test, which I was impressed with. So am I okay or should I get checked anyway? A little worried is all. Where I hit, there is blood under the skin and a little squishy, like I said, he said: "it was a hematoma and should heal on its own."

I got my fourth concussion about 5 weeks ago, my third in ten months. I was in two accidents last year four months apart, then this last one was at work. I've seen the workman's comp doctor and he has turned my care over to a neurologist, whom I can't get into until May. I've been symptomatic this entire time: constant headaches, ear ringing, vomiting, balance issues, blurred vision. I've fallen twice since the concussion, resulting in contusions on my head. The pain and vomiting were so bad last week I went to the ERer, and the doctor said I was wasting his time and he couldn't help me. He also said if I was there for painkillers, I needed to get out of his ER. I felt humiliated and depressed that no one can help me feel better. Was that doctor out of line and what do I do for some relief while I wait to see the neurologist?

I recently rolled my car (3/22/18) and developed a large cranial hematoma. A CT scan was done and they released me. On 3/27, I started having a headache and the goose egg seems to be getting bigger. I don't want to be dramatic and run to the ER. . . . . Suggestions??

GO TO THE ER!

It is important you go. They won't think you are dramatic. They will think you are smart even if it turns out to be nothing. It doesn't hurt to go it could turn into something. You had a very big injury. Something more could have formed such as a head bleed that is deadly. Take my advice go now it can never hurt.

I went to close the tailgate of my car with full strength and hit the middle of my head. This happened Friday, I am still in pain and have headaches. Should I go to the ER? I have had two concussions before this so I'm pretty sure it is a slight concussion

Help, I was assembling a weight lifting chair and before even assembling anything, one of the legs tipped over and hit my head causing a small cut towards the front almost the side of my head. Bleeding stopped very soon and I never lost consciousness but I do feel a little bit dizzy and nauseous. The cut is not bleeding anymore but I'm worried. Should I go to the hospital.

Yes you should go to the hospital!

So i fainted and became unconscious for a min or so my friend was there he said i hit my head on the way fown but i just sat kind of crumbled after i woke up i felt sick to my stomach i stood up after i got my barrings and felt okay to walk i took 4 steps and fainted again ive never had this happen now ive felt tired and achey all over for the past 20 hours or so should i go to the er im really nervous

I really think you should!

Um... you all just need to go to the doctor. If you are even asking that question because you are not feeling “right” in any way after a blow to the head. Then yes, seek medical attention. Better to err on the side of caution...

I just fell of my bike today, messed my elbow up pretty bad. Anyways, I can't remember if I hit my head hard or not at all. There isn't a blemish on my skull. I did some research, and an online test, but I think i'm fine, and it's just the adrenaline. I don't feel "right" but im going to check in with the family after a bit. Just to see if it progressively gets worse. I heard that it can take upwards of 24 hours for symptoms to appear so i'm just a tad worried. But that's just the thing, if you fall, and can't see/feel an issue, how do you even know you hit your head in the first place? For all I know I only scraped my elbow badly. This is a very worrisome issue, but I heard the chances of having a concussion are about 1/1000. If you do suffer from memory loss, fatigue, drowsiness, etc. I'd personally get checked out.

PS: WEAR A HELMET, I'M LUCKY BECAUSE THERE WAS A NURSE AT THE PARK WHERE I WAS BIKING, I'VE LEARNED A VALUABLE LESSON

PSS: After rereading this paragraph I don't sound like someone with a concussion. I'm probs just overreacting.

I hate it when people answer like that!! “Um all you need to do is go to the dr..”

Sarcasm, ad nauseam... I'm with you Jen
There is nothing more precious than life.
Sad that the medical 'business' is beyond affordable to so many, leaving them wondering if they should seek help - when they know the really should, maybe even risking their life to avoid loosing their arm and leg to pay for, in most cases, their assurance.

When I was around 10 yrs old, I was repeatedly kicked in the back if the head around 12 times by a boy, I did tell the teacher and was very wobbly and vision was burred. I'm just wondering if this could of resulted in some sort of damage. I suffer with depression, and my moods have suffered for years. I suffer with memory loss. I can't remember things from when I was young. Would just like an opinion please

Also, I am very sorry that happened to you.

Amanda, you need to see a neurologist.

HI my daughter got hit by a car walking down the road 2 weeks ago. They said she had a contusion on outer left side and seen nothing else. But ever since then she has been very aggressive, crying, and having emotional issues. Could something else be going on that was maybe not seen during the emergency?

Fredia, you need to take her to a neurologist.

I hit the back of my head on a metal bed frame falling onto the bed from standing up 5 days ago, and immediately after it I don’t remember what happened, then I couldn’t move my head until the morning. Since then I’ve had a consistent headache, dizziness, sensitivity to light, drowsiness, and confusion. I went to hospital 2 days ago and they just said to take panadol and nurofen daily and to come back if it doesn’t get better, or gets worse, or the dizziness gets worse or if my balance gets worse or if I get nauseous l, or anything else that could be related. Yesterday I noticed all new things coming up in addition to everything before. I’m very worried and think I should get a scan because I normally have a lot of pain in my body and stuff going on anyway that could be affecting it, and all my friends think I should go back, but my dad doesn’t seem that worried and is saying that it’s normal. What should I do?

Go to a hospital, they can do a CAT scan to look for bleeding in the brain. If in doubt go to the hospital.

I agree, that sounds serious.

These are signs of a concussion. Go back to the hospital.

I was playing ice hockey(still do) about a year ago. I got tripped up and flew about 5-6 feet across the ice while flying about 4 feet off the ground and went head first into the boards. The impact was on the top/back portion of my head(my back was facing the ice and I was going backwards into the boards). Upon impact my head snapped forward(whiplash) I blacked out and remember coming to laying face down on the ice holding my head and the red whistling. At that point I knew I was playing hockey but was a little confused what was going on in the game and knew I had blacked out(not the first time I’ve been knocked unconscious). I ended up sitting out for a little and then went back in to play(I know it was stupid and I was being stubborn). I’ve never gone to a doctor any time I’ve been concussed(yes I know it was a concussion and yes I know I’m stupid for not going). I believe my head has gotten a little messed up, as I forget things I’m talking about and I have developed a slight stutter at times. A perfect example is this post I’m writing right now, I honestly forgot the what I’m commenting on and just know it’s about hitting my head and getting concussions but other than that I don’t even know if I’m commenting on the same “theme” everyone else is. I just know i messed up by not going to a doctor, now I have a completely different injury to my throat/neck and will be seeing a doctor very soon and won’t make the same mistakes again.

You should go to the hospital ASAP before it gets worse. I hope your okay, this sounds scarey.

hi . Today I hit my head in the sport class . My friend had knocked it with the basket ball so hard . I am ok but I fell like my brain is moving , is it normal?

A few weeks ago I fell and the right side of my head bounced off the concrete floor, getting headaches I went to the doctors and was told I had a concussion as I had lost consiousness for a few minutes. Now I am having a problem with vertigo and concussion, plus when I lay on the side where I hit my head I get severe pain on the top of my head and at the back of my ear, plus I get really dizzy and feel sick. I sleep most of the day now, should I worry? I am over 65 years old

Get checked out please.

This is a really interesting chain of messages, in many ways I feel less alone with my own concerns. Please bear with the following, by nature, I'm a worrier and this is ruining my life.

A number of years ago, I walked into a pillar; I was looking the other way whilst walking, looking for someone, then turned around and bang! I was a bit dazed, and the point of contact was on the forehead, just above my left eyebrow. I went into the pub where I was meeting my friends, and I had a massive goose egg bump, with a small cut, which was bleeding. The bar staff were a bit shocked at the bruise and asked if I needed to go to the hospital, but I said no, I was ok - they just stuck a plaster on. I then had a few drinks with mates, then went home; wakened up the following day and felt pretty much ok.

At the same time, I was going through a pretty difficult time in my life, going through University, broken up with a girlfriend, trying to find myself really. Anyway, I just feel at that time, I lost confidence, experienced a really dry mouth when speaking to people, and seemed to slur my words quite a lot. This is still the case years later, and I keep thinking if this is the result of the head injury - was it totally innocuous, or should I have gone to the hospital? Have I just got generalized anxiety, which is causing the dry mouth, etc?

I know the above may sound pretty minor to others who have posted on here, but this has become an obsession for me and has ruined my life. Am I worrying about nothing ref the bump on the head? Really appreciate feedback on this guys.

If I were you I'd go see a doctor and tell them my concerns. A head injury is a serious thing, it's your head and when we are not at 100%, our bodies will try and protect and heal. I'm offering up a special prayer for you. It sounds like you have a lot going on. Good luck and God bless you.

I fell and hit my forehead three months ago causing concussion. Still off work now suffering from anxiety and depression. Up until then I was perfectly healthy definitely think it was the blow to the head.

I hit the back of my head after falling Straight back from only standing height. I don’t feel sick or dizzy but have a head ache that mostly disappears with paracetamol. But I do have a bruise feeling on the area where I hit my head-do you think I’m fine and it should just go away?

I did this exact same thing and have the same symptoms!

Hi! My boyfriend hit his head (eyebrow part) on the ground so hard in the past -- 8 years ago. He briefly lost his consciousness and had a severe headache. And after that day the pain disappeared. And now he's experiencing an everyday headache (mild & severe) and sometimes dizziness. I'm so worried about his condition. Do we need to see a neurologist to check his head? How much does it cost?

I hit my head 3 nights ago. I have a severe headache that hasn't gone away. My vision gets really blurred when I drive and sometimes at work I lose balance. I hit my head last year in an accident on the left side. When I fell this time I hit my forehead on my hairline. Should I go to the hospital?

definitely go!

Id definitley go to the hospital if i was you.

yes! go to the hospital

Yes!! Now!

I hit the base of my skull around five days ago, I was sleepy, draining mucus, I have loss of memory and for two days I felt in a daze/with slow responses. At this point my husband and I agree I had a concussion. However now I have this straining pain on the side were I hit my head and in my neck. It's as if my heads pulling down that direction. I also have stiffness. Should I go to the hospital it's an old injury now

There is a certain spot on my head that is SORE when I touch it. I have hit my head SO MANY times in the recent past month or so, banged it on the top bunk getting into bed, banged it on the car trying to get something in or out of it, and I even hit my own head when I have a migraine and the pain just doesn't seem to MOVE out of that one location, I thought it was a bruise but it's been hanging around way too long for that, so any one of these might have caused me to possibly have cracked my skull. I do not feel a knot, but when I find that spot that is sore when scratching my head, I seem to feel nauseous until I leave it alone...The nausea & pain stops whenever I leave it alone. I have noticed that I have been extremely ANGRY here of late, but I thought that was due to me being bullied at work and then let go when I was the hardest temp worker they had and expected to stay! I don't have any money to go to the doctor with. Hospital charges an exhorbitant amount of money. $3k just for a bladder infection diagnosis, in and out in less than two hours! Maybe it's just a bump, like in acne, but I cannot seem to be able to find it. I don't want to injure my brain in case it is an indention injury that is not healing! Now I"m lying awake and cannot sleep at the thought of this!

Hi! So I'm 11 and just today I hit the top of my head on the playground. I experienced severe headaches throughout the day, also I heard that sleepiness is a symptom as well. I've also had a little bit of nausea and dizziness. Should I go to the doctor?

I got hit on the top of my head with a pry bar traveling very fast and attached to heavy equipment. Thankfully I was wearing a hard hat and it took the brunt. I have been nauseous but not vomiting, dizzy, hard time thinking normally, blurred vision, headaches and I find it hard to open both my eyes. I saw a dr. who sent me home with a prescription for alive. My pain in neck and shoulders is increasing and pressure on my head also hurts. The dr. did not give me a cat scan because he said he did not think I was bleeding and there was a radiation risk with the scan. Should I go back???

Probably because the way you describe it it sounds like the pressure is the blood pushing up against your brain.

I fell last night on ice. It happened so fast I couldn't brace myself. I fell back and hit the back of my head. I had alot of aches and pains and a headache and nausia. I felt a little like I was watching tv. Sort of disconnected. I didn't loose consciousness but my vision got dim/dark for a minute. I woke up at 3 am this morning and had no balance at all. Went back to sllep til 6am and I'm not so off balance but something is different for sure. Other then the pain in my back and neck.
I have been in a auto accident where someone hit me head on almost 10 yrs ago and I did loose consciousness briefly then. I was dx with a mild TBI then. Could this just be my old symptoms being aggrrivated?

If you still have a headache or any nausea, then you probably have a concussion. Not an old one, a new one. I just fell on ice last night as well and hit my head. I have a mild concussion currently. And I've had 7 or 8 previous concussions.

I recommend going to see your primary care and just tell them you fell, hit your head. And ask, do you think I have a concussion? Yes, there is a test to determine if you have one or not. Not every concussion is the same.

Good Luck!

Ok, I'm 15 and yesterday I hit the side of my head on the car door and have had headaches since. Today, I was laying down and I told my mom to hand me my phone and she ended up dropping it on the side of my head I hit yesterday. My mom tells me I'm worrying too much and we don't have insurance. Advice?

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