A difficult time...
In cases of serious brain injury, a person will need to be taken to hospital for medical treatment. The exact type of treatment they require and the urgency of this will depend on the type of injury they have sustained. A person may need to undergo investigations, surgery and/or nursing care. They may require treatment in an emergency department, intensive care unit and eventually a general hospital ward.
The whole experience of being treated in hospital for a brain injury can be upsetting and frightening, both for the person themselves and their family. There may be many questions that hospital staff are unable to answer at this early stage, and it is unfortunately not possible to know the long-term outcome of the injury at this point.
Below we offer information on hospital treatment after brain injury, most relevant for injuries caused by an accident or assault. More specific information on the treatment of different types of brain injury is available on Types of brain injury.
Supporting you
We understand that this is likely a difficult time for everyone involved. We also recognise that some of the information shared below may be hard to work through at this stage.
Contact our nurse-led helpline for information and emotional support, including if you just want to talk to someone about your feelings or concerns through this difficult time. You can also check out our online communities to connect with others going through similar stages.
Remember that our services are available for those both directly affected by brain injury and their loved ones.
The emergency department
After the accident, the person with brain injury should be taken to the nearest emergency department, where a doctor will carry out an initial assessment. After a serious accident it is possible that there may also be other injuries that need more urgent attention.
Doctors will make an assessment and prioritise the treatment required based on the most urgent clinical need. The medical team will check breathing and any blood loss, replacing any blood that has been lost with a transfusion.
If the person is unconscious, they will be unable to keep their throat clear and a tube will be put through their nose or mouth into the windpipe to help with breathing. This is called an endotracheal tube and is connected to a ventilator, which takes over the person’s breathing mechanically. This ensures that the brain is kept well supplied with oxygen.
Medical staff may arrange various X-rays and will also check for further complications, such as blood clots or bleeding in the brain. To do this they will need to carry out a CT or MRI scan of the head.
The neurosurgical unit
After the initial assessment, the doctors may decide to send the person to a neurosurgical unit. This will help to obtain a much clearer picture of the brain injury, its potential effects and what treatment is needed. Neurosurgical centres are frequently based in major cities and so the person may need to be transported a long distance by ambulance or helicopter.
On arrival, the neurosurgeon will usually review the scans done at the local hospital or arrange for a brain scan if this was not done. This will help them to assess the extent of damage to the brain and decide whether an operation is necessary.
Neurosurgery
If there is a blood clot large enough to damage the brain, or if there is pooling of blood or cerebral oedema, an operation will be needed. During surgery, a flap of bone is cut out of the skull over the site of the clot (a ‘craniotomy flap’). Once the clot has been removed and damaged blood vessels repaired, the bone will then be replaced. In certain circumstances the bone may be left out and not replaced until later on in the recovery process. This decision will be made by the neurosurgeon during surgery.
The skull heals rapidly and normally leaves no area of weakness. Many people are particularly worried about the effects of an operation on the head, but in fact, the surgery itself is usually straightforward and without much risk. The most important factor is the injury that made the operation necessary in the first place.
An operation will also be needed if there is a wound that goes through the skull into the brain. Wounds of this sort may look frightening, but with proper treatment the external injury can often heal well. As with any traumatic brain injury there could be a future tendency to epileptic seizures, known as post-traumatic epilepsy, following this type of injury. The patient may be prescribed specific medication to reduce the risk of this occurring.
A neurosurgical operation is a delicate and lengthy procedure and can take a very long time. After the operation the person may take a long while to recover consciousness. This can be as a result of the anaesthetic, but is more often the result of the brain injury itself. The overall rate of recovery will depend on the severity of the brain injury, rather than on whether or not an operation has been performed.
Intensive care unit
After any neurosurgery has been carried out the person may be taken to an intensive care unit (ICU) or neurological high dependency unit (HDU). Here they will be looked after 24 hours a day by highly trained staff, using specialised equipment to assess and treat them.
Just as in the early stages, staff will be checking the person’s heart rate and blood pressure, testing brain function and controlling intake of fluids and food. Drugs may be used to keep them sedated at this time. The main priority is to reduce the risk of further damage while any bruising settles down and to prevent any further swelling of the brain.
The intracranial pressure may be carefully monitored using a special tube inserted into the head, usually called an intracranial pressure (ICP) monitor. This will not do any damage and will only leave a tiny scar under the hair. It will enable the doctors to know whether drugs are needed to relieve swelling and increased pressure.
In the early stages a drip (or IV, for intravenous infusion) may be used to supply the person with essential nutrients. Once they are past the emergency stage, but are still unconscious or unable to swallow, food may then be fed to them using either a nasogastric tube (which is placed through the nose and into the stomach) or a percutaneous endoscopic gastrostomy tube (more commonly called a ‘PEG tube’).
This can be a confusing time for families, as the person with a brain injury may be taken off for a series of tests, assessments or even operations. Be sure to ask the medical staff if you are unsure what is happening.
If you feel that your questions have not been fully answered, you can make an appointment to see the consultant in charge of your loved one's care. This will give you more time to discuss any concerns. Before the appointment write down any questions as you think of them, so that you don’t forget to mention them to the consultant.
Coma
In cases of serious injury to the brain, an immediate consequence can be a loss of consciousness. If this lasts for longer than 6 hours, the person is in a coma. While in a coma, they will need to be treated in an intensive care unit.
A person in a coma may look like they are asleep, but they cannot be woken up. They do not respond to any stimuli, such as touch, light or sound, nor can they make any intentional or purposeful movements. They may cough or swallow, but these are reflexive and not intentional.
Unfortunately, nobody can tell how long a coma will last for. In many cases they last for a few weeks, but this can be much shorter or longer, and will depend upon factors such as the person’s age and the extent of their brain injury.
In some cases, a person will have intentionally been placed into this state by clinicians at the hospital. This is called an induced coma. This will be done by administering specialist medications. It will be temporary and carefully controlled.
Further information on comas, including what happens after a coma, is available on Coma.
Headway's Emergency Fund
"We were going to the hospital every day, but we could only visit for an hour at a time. We went up three or four times a day, backwards and forwards, to the hospital. I felt so scared and helpless."
Read more of Tracy's story, or find out more about how our Emergency Fund can help you during this difficult time.
General hospital ward
Once they are out of the emergency stage, there is less need for intensive nursing and the person may be moved onto a general hospital ward.
The person may still be highly dependent on nursing care. They may not be able to swallow properly yet and may still require the nasogastric tube that was used for feeding while in intensive care. They may not have recovered enough strength to hold their head up, or to sit up on their own and may not be able to communicate properly yet. However, they will know, even if in a rather confused way, that their family and friends are with them and this will be a comfort and a great source of strength to them.
You may feel at this stage that you want to do more for your loved one and you can discuss this with the nurse in charge. You may be shown how to take over simple nursing tasks or rehabilitation exercises, although it is important that this is done under the supervision of the hospital staff, since if things are done wrongly they can cause further complications.
After hospital treatment
Once a person with a brain injury is medically stable and any physical injuries have been treated, they may be ready to be discharged from the hospital, or ‘acute care’ setting. However, many of these individuals are likely to experience complex, longer-term physical, cognitive and behavioural problems, which require a period of rehabilitation. More information on this is available on Rehabilitation.
If it is decided that your loved one is ready to return home, the hospital will start the process of discharging them. It is very important that this is done safely and carefully, and that you feel comfortable with the arrangements made before they are discharged. More information on this is available on The discharge process.
Guidance for families and loved ones
We understand how difficult it can be to have a loved one being treated for brain injury in hospital. You will naturally be concerned for their recovery and will want to spend as much time as you can by their bedside. However, it is important that you look after yourself through this time as well. There will also likely be many practical arrangements to make in the meantime.
Specific guidance for families and loved ones at this stage is available on Care during hospital treatment and early recovery, with further general guidance being available on Looking after someone with brain injury.
NHS patient support services
The following services are available to offer support for patients being treated in hospital and their families.
England and Wales
In England and Wales, the Patient Advice and Liaison Service (PALS) is a source of advice and support at every NHS hospital. PALS can help to deal with any concerns you have about your loved one’s treatment and help to arrange meetings with consultants. You can find details of your local PALS service at the hospital reception desk or website. Alternatively, you can search for a PALS service in your area on the NHS website.
In Wales, Llais Wales can also provide advice and support.
Scotland
In Scotland, the Patient Advice and Support Service (PASS) can offer information and be contacted through your local Citizens Advice.
Northern Ireland
The Patient and Client Council (PCC) in Northern Ireland offers support for concerns or complaints, and you can discuss issues with their Patient and Client Support Officers (PCSOs).
Channel Islands
The Patient Advice and Liaison Services (PALS) is also available in Jersey. In Guernsey, the Customer Care Team is the first point of contact for giving feedback on Health and Social Care.
Isle of Man
On the Isle of Man, Manx Care Advice and Liaison Service is available for concerns and queries about health and social care.
