When to Go to the Emergency Department After a Concussion
Patients who develop worsening symptoms after a concussion should go to the Emergency Department immediately, particularly if they experience repeated vomiting, worsening headache, confusion, focal neurologic deficits, abnormal behavior, increased sleepiness, or seizures. 1
Red Flags Requiring Immediate ED Evaluation
Concussion patients should seek immediate emergency care if they develop any of these symptoms:
- Repeated vomiting - More than once or persistent nausea that won't resolve
- Worsening headache - Especially if severe or progressively intensifying
- Confusion or memory problems - Increasing disorientation or inability to recognize people/places
- Focal neurologic deficits - Weakness, numbness, or coordination problems on one side of the body
- Abnormal behavior - Personality changes, irritability, or agitation that is worsening
- Increased sleepiness or loss of consciousness - Difficulty staying awake or passing out
- Seizures - Any seizure activity after head injury 1, 2
Initial Home Management After Concussion
For patients with mild concussion who have been assessed and cleared by a healthcare provider:
- Physical and cognitive rest is recommended for the first 24-48 hours 2
- Home observation by a responsible adult is appropriate
- Frequent waking or assessment of pupils is NOT recommended by current guidelines 1
- Monitor for development of any red flag symptoms listed above
Follow-up Recommendations
- Schedule follow-up within 24-72 hours to reassess symptoms 2
- Most concussion symptoms resolve within 3 weeks to 3 months 3, 4
- Consider referral to a concussion specialist if symptoms persist beyond 2-3 weeks 2
Postconcussive Symptoms Education
Patients should be informed about common postconcussive symptoms, which may include:
- Headaches
- Dizziness and balance problems
- Nausea
- Vision problems
- Sensitivity to light and noise
- Memory and concentration difficulties
- Sleep disturbances
- Fatigue
- Mood changes (irritability, anxiety, depression) 1, 2
Return to Activities
- Patients experiencing postconcussive symptoms should refrain from strenuous mental or physical activity until symptom-free 1
- May require 2-3 days off work or school initially 1
- Return to activities should follow a graduated protocol once symptoms have resolved 2
Important Caveats
CT imaging is not routinely needed for all concussions but should be considered if there are concerning symptoms or risk factors (age ≥65, focal neurologic deficit, vomiting, severe headache, etc.) 2
Athletes require special consideration - they should not return to play until completely symptom-free and cleared by a healthcare professional with concussion management experience 1, 2
Children and adolescents may have longer recovery times and require more conservative management 1, 2
Previous concussions may increase risk for prolonged symptoms and should lower the threshold for seeking medical attention 4
By recognizing these warning signs and seeking appropriate care, patients can ensure proper management of concussion and reduce the risk of complications.