When to Go to the Hospital

Jeffrey Bazarian, MD
Question: 

People 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!

When in doubt, go to the hospital!

 

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Posted on BrainLine April 8, 2009. Reviewed March 28, 2019.

Comments (794)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Mila replied on

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.

Rebekah replied on

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

Joe Burghard replied on

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?

Natalie replied on

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

Lora replied on

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!

Laura replied on

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.

DD replied on

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?

Jack Bicknell replied 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

De replied on

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.

Anonymous replied on

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.

Lovely replied on

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

Mary Magdalen replied on

Slipped and fell backwards in a train 2 fays ago. Back of head hit a hard surface. Was shaken up a little and developed a swelling on head followed by persistant headache. Restless sleep. Feeling Nausea. Doctor prescribed treatment for headache only. Is there need to get further treatmwnt please? I am 63.

Suzanne replied on

I fell face first into The doorframe 6 weeks ago. I didn’t break my nose yet had lots of bruising. It took 10 days to look decent enough to go out in public. Now I wake up with numb/tingling in both feet and hands. Had an MRI. It came back normal. I had forgotten to mention my fall to the dr. And the mri tech. Can an MRI show if I have water on the brain or bleeding on thembrain

Myrna replied on

I hit my head while in the bathroom last week while having to pick something up and again tonight . I’m gonna go to doctors and get ct scan performed also. Better to be safe than sorry

C. Lee replied on

Is it possible to receive a brain injury and not show symptoms for a couple of days?

Adrian replied on

My roommate cut himself by accident in front of me. I got so scared that I fainted and hit my head on the floor.
My roommate tells me that after I hit the floor, my eyes rolled all the way to the back and I had a seizure but it only lasted 3-5 seconds. Then I stood up and went back to normal.
I feel good today, I only feel a minor bruise in the back of my head.
Should I go to the DR. or am I overreacting??

Nestorbalote replied on

And u see the the house falling down ? Maybe they see it as seizure cuz of that and u go to the hospital ? Please reply ASAP

Hazel replied on

I fell hit my head 2 weeks ago , went to hospital had CT scan no brain bleed. Have increased tiredness and a little nauseous. I am also short winded even when resting. I feel like I just ran up a flight of stairs.

Louise replied on

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.

Christina replied on

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

Olivia replied on

Same here. Do you feel pressure on your temples? I feel that then get light headed and my legs feel weak. Only been happening a few days after my incident

LaWana replied on

Consult with your m.d. about having a MRI done.

Brenden replied on

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??

Connor replied on

I would man. Sounds scary

Skye replied on

You should definitely go to the hospital asap

Bobbie replied on

Yes felling like that isn’t normal any time your not your normal self go to the doctor you should know what’s normal and you and what’s not you.

Justin replied on

Did you go to the hospital? What happened?

Anna replied on

Yes these are signs you need to go ASAP

rylie replied on

yes, most defiently i would have someone else drive you there. yeah you could have brain damage

Anastasia replied on

Yes,pls u should go to the hospital and check out if every thing is fine.

Hi replied on

Yeah go to the hospital

Nikki replied on

Yes. Absolutely go.

Megan replied on

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.

Recoveringathome replied on

Yes go to the hospital. It doesn't matter what time it is the fact is you have persistent symptoms. And if you leave it you could end up being placed back in a position that makes it worse or you could potentially die in your sleep especially in the first 24 hours. It happens. You dont want that so go in even if it's only slightly affecting you. Better to be safe then sorry

Tanya replied on

I hope you went to the hospital and you are ok..I happened to read your comments on here about your head injury but just realized it was back in April so I'm hoping the outcome was good for you..

Marie Elizabeth replied on

Should you always go to the hospital when you hit your head and have a lump and are just stressed and scared and just have a slight headache from nerves maybe

Mea foodie replied on

I hope you went to hospital and are okay

Concerned replied on

I hope you did go to the hospital if not go right now. Even if you are feeling better. Since you were dizzy and had vision disturbances after falling.

Jordan replied on

Never resume activity after a hit to the head that leaves you dazed. At that point you’re brain is basically weakened, and if it will be much more sensitive and vulnerable to getting shaken around from al the jumping and what not while cheerleading, possibly worsening the injury. If you’re still having symptoms, my number 1 advice is don’t hot your head again anytime soon. Avoid it at all cost. Like don’t even bump your head on the headboard when going to sleep. Nutritious food (fatty fish esp), limit screens in the evening and night so you can get to sleep at night, get morning sunlight (which will also
help you sleep at night), go for walks, etc.

Kim replied on

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."

teresa replied on

So did u get a CT

Angela replied on

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?

MP replied on

Yes. The doctor was completely out of line. You should have asked to speak to a hospital administrator or the appropriate person over him. Report him to the proper authority and don’t back down. Given your symptoms you could have been/or are in serious condition. Seek a second opinion if u haven’t already. Gl.

Bridge replied on

Seriously, you need to get a 2nd opinion, that Dr needs striking off! I have been to A&E today with the same as you and the consultants did a thorough check and a CT scan too. I'm okay just concussion no bleeding in the brain but I now have to take time off work and rest up. Take paracetamol only and get plenty of rest and it could take a while to get better, if not better this time next week I am to go straight back up to A&E. I feel crap but confident of full recovery having been to A&E but wish I'd gone straight away which is what they told me I should have done. Good luck, I hope you get it sorted soon. If not then lodge one helluva a complaint and remember to the Doctor's name for the complaint. If you have to wait for the Neurologist then I suggest you take the time out to rest up and take paracetamol only whilst you do.

Cetkat replied on

It's a little late; but, yes.. the doctor was out of line. If you ever deal with that again, you should retort that you're not here for the pain (though of course it's a concern) - you're here because you've had multiple head injuries and haven't been able to access proper care and accessment. You need a consult with the neurologist on call and to get any imaging they think you my need -- that your first injury hasn't improved & has directly caused additional head injuries & you need that to stop happening. Also, if you get shit on like that again, you can tell the nurse you need to speak to a social worker. They can advocate on your behalf. I hope things are better now.

Abdullahi replied on

The way he treated you wasn't nice, though I can't tell the manner of approach you did or how you explained your condition. But I'll advice you to see another medical practitioner. (I'm not a specialist though, just my opinion).

#concussed replied on

Hey there. That doctor seems way out of line. Brain injuries are very serious and considering you have persisting symptoms they should of done some scans to make sure everything was okay and rule out any bleeding in the brain. You can take panadol but don't take anything like ibuprofen. Also dont drink alcohol as it thins your blood

Teri replied on

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??

Anonymous replied on

Have you put ice or something cold on it?

Rebecca replied on

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.

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