For a head injury, is it the ER or Urgent Care

For a head injury, is it the ER or Urgent Care?

Head injuries are more common than many people realize-and they often occur at home. According to a study published by the National Library of Medicine using data from the National Electronic Injury Surveillance System (NEISS), nearly 20 million head injuries were treated in U.S. emergency departments between 2014 and 2024.

In adolescents, injuries were commonly associated with organized sports equipment used in football, basketball, soccer and baseball. Among older adults, falls involving floors, beds and stairs were the leading contributors.

"A head injury is a broad term that covers a wide range of situations," said Michael Hall, MD, MPH, an emergency department physician and chief of emergency medicine at Cape Cod Hospital in Hyannis. "You might stand up and bump your head on a kitchen cabinet, and that's considered a head injury. Or you could fall down a flight of stairs and hit your head-that's also a head injury. The severity can vary greatly, which is why it's important to know when medical evaluation is needed and where to go."

The details of how you hit your head and the circumstances surrounding the injury provide very important information for the attending physicians.

"One of the first questions we ask-whether it's a child or an adult with a head injury-is 'did you lose consciousness?'" said Dr. Hall. "Sometimes, people are unsure, but if they respond that they absolutely did not lose consciousness, that is very reassuring."

Losing consciousness following a head injury can be a symptom of a concussion or something more serious, such as a subdural hematoma.

Assessing A Head Injury

Some additional questions provide further information to assess the extent of the head injury, and they include:

Adults:

• Do you take anticoagulants (blood thinners) such as Eliquis, Xarelto, Coumadin, Lovenox, or Pradaxa?

Adults and children:

• How did you feel after you hit your head?
• Have you been vomiting repeatedly?
• Do you have a persistent, severe or progressively worsening headache?
• Are you experiencing any confusion or memory loss?
• Have you had any vision changes, including double vision?
• Do you have difficulty walking or weakness?
• Do you have slurred speech or difficulty talking?

Emergency Department or Urgent Care?

Head injury patients who should be seen at an emergency room, according to Dr. Hall, are those who:

• Have lost consciousness and/or are taking an anticoagulant.
• Are vomiting repeatedly.
• Are confused.
• Have worsening symptoms.
• Have a severe headache.

Head injuries appropriate for an urgent care center are those who:

• Bump their head and have a slight headache and are otherwise normal.
• Are not taking a blood thinner.

Dr. Hall reassures patients that even if you go to urgent care and there is an issue the provider is concerned about, the patient happens to be advanced age, they think there may be another medical condition or need a CT scan, they will send you to the hospital emergency center.

"All of the Cape Cod Healthcare Urgent Care Centers are staffed by emergency department (ED) physicians or advanced practice clinicians (APC) who work alongside the ED physicians, and we see these types of injuries every day, so we immediately know what to do," he said.