Head Injury: How Long to Stay Awake & When to Go to the ER

After a head impact, stay awake and monitored for at least 30–60 minutes. The old "keep them awake for hours" rule is outdated—what matters is symptom progression.

Immediate Red Flags → ER Now

• Loss of consciousness >30 seconds
• Repeated vomiting
• Severe/worsening headache
• Confusion, disorientation, agitation
• Unequal pupils, double vision
• Weakness, numbness, slurred speech
• Seizure
• Clear fluid from ears/nose (CSF leak)
• Bruising behind ears (Battle's sign) or around eyes (raccoon eyes)
• Infant: bulging fontanelle, inconsolable crying, refusal to eat

Observation Period

• Mild bump, no LOC, no symptoms: Observe 2–4 hours awake; then normal sleep is fine. Wake q2–3h first night to check arousability.
• Any concerning symptom: ER immediately—do not wait.
• On blood thinners / age >65 / bleeding disorder: Lower threshold for CT scan.

Concussion Protocol

1. Physical & cognitive rest 24–48h.
2. Gradual return-to-learn/play per protocol (CDC, Zurich guidelines).
3. No same-day return to sport.

When in doubt, get checked out. A normal CT doesn't rule out concussion; clinical judgment guides management.