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Concussion Signs Requiring Immediate Hospitalization

Close monitoring in first 24-48 hours especially critical for young athletes

While most sport-related concussions are mild, the potential always exists for a more serious, life-threatening head injury, such as an epidural hematoma (bleeding between the skull and the brain).

It is particularly critical that an athlete suspected of having a concussion not be left alone and should be monitored for signs that require immediate hospitalization.  Some experts recommend monitoring for the first 24 to 48 hours (1, 2), while others use a cut-off of four hours of frequent observation, with a check at least every 15 minutes, after which the athlete can be allowed to rest. (3)  

An athlete must go to a hospital emergency room  if he or she:

  • Has a headache that gets worse and does not go away
  • Is very drowsy or can't be awakened (woken up)
  • Can't recognize people or places
  • Is vomiting repeatedly
  • Behaves unusually
  • Becomes increasingly restless or agitated
  • Experiences convulsions or seizures (arms and legs jerk uncontrollably)
  • Has weak or numb arms or legs
  • Is unsteady on their feet 
  • Has slurred speech
  • Has one pupil which is larger than the other
  • Loses consciousness (even briefly)
  • Will not stop crying/cannot be consoled
  • Their symptoms get worse.

The advice to parents: err on the side of caution.

1. Sports Concussion Assessment Tool 3. Br J Sports Med 2013;47:259.

2.  Pocket Concussion Recognition Tool. Br J Sports Med 2013;47:267. 

3.  Kutcher JS & Gerstner J. Back in the Game: Why Concussion Doesn't Have To End Your Athletic Career. (Oxford University Press, New York 2016). 

Revised September 16, 2016