Monday, August 5, 2019

When to Seek Medical Attention After Hitting Your Head


By My Le, MD
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association

When you hit your head, it can be difficult to determine whether the injury is serious enough to visit the emergency room or an urgent care center – especially when there are no open wounds, and you’re awake, alert, and feeling pretty normal. If you decide to make the trip, it can be frustrating to be sent home with no action by the doctor besides instructing you to pay attention to your symptoms and come back if they worsen. On the other hand, if you don’t go, there could be serious medical repercussions. 

First and foremost, if you or the person who has suffered a closed-head injury (meaning no penetrating or open wounds) is showing any changes in alertness or wakefulness, or you can feel a skull fracture, go to the emergency room. A trained medical professional will usually assess that patient with a cranial computed tomography (CT) scan. This test, which takes detailed scans of features inside your head, allows doctors to look for potential injured blood vessels, blood clots, bruised/damaged brain tissue (contusion), bleeding in the brain (hemorrhage), and swelling. 
Below are some concerning symptoms by age group that can appear after a closed-head injury. If you or the patient do not have any of these symptoms and are otherwise feeling well, going to the emergency room or an urgency care center might not be necessary. However, the more of these symptoms you have, the higher the risk your head injury is serious.

For patients less than 2-years-old:
  1. Scalp hematoma – This is essentially a collection of blood under the scalp and can be described as a large, boggy area of swelling.
  2. Severe injury – This can be pretty subjective, but it’s always good to consider multiple factors, such as height of the fall, the material that the head struck, and the speed of injury.  For example, some literature considers a high-speed accident (more than 40 miles per hour), a fall greater than three meters, or an injury from a high-speed projectile or object as severe.
  3. Loss of consciousness for more than five seconds (i.e. blacking out).
  4. Abnormal behavior as witnessed by family or friends.

For patients ages 2 to 18-years-old:
  1. ANY loss of consciousness
  2. Vomiting
  3. Severe injury (see above for details)
  4. Severe headache
A patient’s recovery from a closed-head injury can vary depending on how severe it is. People with milder symptoms typically recover in a few weeks. But patients who suffer from more serious head wounds will likely have long-term issues with attention, memory, coordination, balance, hearing, vision, and/or behavior. Moderate to severe head injuries can even lead to a shorter lifespan.
Your head is a delicateand essentialpart of your body. Understanding what physicians and other trained medical professionals look for when caring for a patient with a potential closed-head injury, and understanding the injury’s warning signs, can guide you when deciding whether you need to visit your local emergency department or urgent care center.

Reference(s):
PECARN Pediatric Head Trauma CT Decision Guide

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