For most concussions, the hospital’s job is to rule out something more dangerous, monitor you for a set period, manage your pain, and send you home with clear instructions. A concussion itself doesn’t require surgery or specialized treatment. What the hospital provides is a careful evaluation to make sure there’s no bleeding, swelling, or fracture inside your skull, followed by a structured observation period to confirm your condition isn’t worsening.
The Initial Assessment
When you arrive at the emergency department after a head injury, a nurse or doctor will first assess how alert and oriented you are using the Glasgow Coma Scale. This is a simple scoring system that checks three things: whether you can open your eyes, respond verbally, and move on command. Scores range from 3 to 15, with a concussion typically falling between 13 and 15 (classified as mild traumatic brain injury). Your score helps the team decide how urgently you need imaging and how closely you’ll be monitored.
From there, you’ll go through a neurological exam. This sounds intimidating, but most of it involves straightforward physical tests: the doctor will shine a light in your eyes to check pupil response, ask you to follow a finger through different positions, test your grip strength and reflexes, check your balance, and ask orientation questions like where you are and what day it is. They’ll also feel along your head and neck for tenderness or swelling and check your neck’s range of motion. The goal is to identify any “focal” neurological signs, meaning problems that affect one specific part of your body and could indicate a more serious brain injury.
Whether You’ll Get a CT Scan
Not everyone with a concussion needs a CT scan. Hospitals use validated decision rules to avoid unnecessary radiation while still catching dangerous injuries. The most widely used tool for adults is the Canadian CT Head Rule, which identifies specific risk factors that warrant imaging. You’ll almost certainly get a scan if any of the following apply:
- Your alertness score hasn’t returned to normal within two hours
- Suspected open skull fracture
- Signs of a fracture at the base of the skull (bruising behind the ears or around the eyes, clear fluid leaking from your nose or ears)
- Vomiting more than twice
- Age over 65
Two additional factors push toward scanning even if those aren’t present: memory loss of more than 30 minutes before the injury, or a dangerous mechanism of injury (like being hit by a car or falling from a significant height). These criteria are highly sensitive. The high-risk factors alone catch 100% of injuries that would need surgical intervention, while only requiring about a third of patients to actually undergo CT. An MRI is rarely done in the emergency setting. It’s sometimes ordered later, in follow-up, if symptoms persist.
How It Works for Children
Kids get evaluated differently because younger children can’t always describe their symptoms clearly. Hospitals use the PECARN algorithm, which separates children into two age groups. For children under 2, doctors look at mental status, behavior changes reported by caregivers, loss of consciousness, scalp swelling (especially if it’s not on the forehead), and signs of skull fracture. For kids aged 2 to 15, the checklist focuses on mental status, loss of consciousness, vomiting, severe headache, signs of a skull base fracture, and whether the injury involved a serious mechanism like a high-speed collision. If a child meets all the low-risk criteria, imaging can safely be skipped. Symptom identification is particularly difficult in children under 2, since their presentations tend to be vague, so doctors rely more heavily on physical findings and caregiver observations.
The Observation Period
If your CT scan comes back normal, or if you didn’t need one, the hospital will typically observe you for about six hours from the time you arrived. During this window, staff will check on you periodically to make sure your symptoms aren’t getting worse. They’re watching for declining alertness, new vomiting, increasing confusion, or the emergence of any neurological changes that weren’t there before.
If your alertness score stays at 15, you have no focal neurological problems, and your mental status remains normal throughout this period, you’ll be discharged. Most concussion patients go home the same day. Overnight admission is reserved for people whose symptoms are worsening, whose scans showed something concerning, or who don’t have someone at home to keep an eye on them.
Pain Management in the Hospital
Concussion headaches can be intense, and what the hospital gives you for them matters. Acetaminophen (Tylenol) is the preferred pain reliever. Ibuprofen, aspirin, and other anti-inflammatory drugs are avoided in the early period after a head injury because they thin the blood and could increase the risk of bleeding inside the skull. If you’re managing pain at home after discharge, the same rule applies: stick with acetaminophen and avoid ibuprofen or aspirin unless a doctor specifically tells you otherwise.
What You’re Told at Discharge
Before you leave, you’ll receive a set of discharge instructions. These are critical because the most dangerous changes after a concussion sometimes develop hours or even days later. Hospital discharge sheets typically list specific warning signs that should bring you back to the emergency department immediately:
- A headache that keeps getting worse or won’t respond to pain relievers
- Vomiting more than three times
- Becoming increasingly sleepy or difficult to wake up
- Seizures
- Slurred or confused speech
- Weakness or numbness in your arms or legs
- Double vision
- A stiff neck
- Fluid or blood leaking from the nose or ears
- Changes in behavior, such as unusual irritability or confusion
Someone should stay with you for the first 24 hours after discharge to watch for these signs. The old advice about waking someone every few hours through the night has fallen out of favor in many guidelines, but having a person nearby who can recognize worsening symptoms remains essential.
The Recovery Plan You Leave With
Hospitals no longer tell concussion patients to lie in a dark room for days. Current guidelines recommend a brief period of symptom-limited rest (typically 24 to 48 hours), then a gradual return to normal activity. The standard approach follows a stepwise progression, where each stage takes a minimum of 24 hours, and you only advance if you’re not experiencing new or worsening symptoms.
The stages move from everyday activities like light household tasks and returning to school or work, to light aerobic exercise (5 to 10 minutes of walking or stationary cycling), then to sport-specific drills, noncontact practice, full-contact practice, and finally unrestricted activity. For non-athletes, the same principle applies in a simpler form: ease back into your routine gradually, and if symptoms flare up at any stage, scale back and give it more time.
Most concussion symptoms resolve within two to four weeks in adults, though some people experience persistent symptoms for longer. The hospital visit itself is relatively brief for most patients. Its purpose is focused and specific: confirm there’s nothing requiring emergency intervention, make sure you’re stable, and equip you with the knowledge to manage your recovery safely at home.