The European version features different and more violent kills and the complete hospital showdown has been re-cut completely.
- In the European version Billy dies on an operating table as doctors try unsuccessfully to revive him.
- Leigh (Kristen Cloke) is taken to the morgue to ID Agnes and finds Clair's (Leela Savasta's) remains in the body bag marked for Agnes. Leigh returns to Kelli's ('Katie Cassidy''s) room to find Agnes hiding in the bed pretending to be her. Agnes attacks Leigh and snaps her neck. Kelli returns from getting X-rays done, is attacked by Agnes and kills her by shocking her to death with a defibrillator.
- Kelli is picked up by her parents and leaves the hospital and the camera zooms in on a PEACE ON EARTH sign hanging on a door.
- In the US version Billy drops down through a ceiling tile after Agnes is killed and chases after Kelli. Kelli breaks the window to her room and runs out into the hallway with Billy close behind. He fights with her before ending up falling over a railing and being impaled on the star on top of a Christmas tree in the lobby below.
In the UK version Melissa's death is entirely different. Instead of breaking free from the garbage bag and eventually getting an ice skate through the back of her head, she gets bagged and her right eye is gouged out. She is then dragged by the empty socket down the hallway and killed (off-screen).
The unrated DVD adds the following scenes:
- 1. There is an extra shot of Agnes under Clair's bed in the opening scene.
- 2. When the security guard is killed in the nut house, there's an extra shot of Billy climbing up from under his bed, and another shot of blood dripping from the guard's neck.
- 3. In Megan's death scene, there is an extra shot that shows the weapon Agnes stabs Megan with.
- 4. The phone call scenes are more brutal.
- 5. There's a completely new scene that shows Lauren's death.
- In the scene, Billy and Agnes sneak into Lauren's room while Lauren's asleep.
- Billy starts touching her under the covers and Lauren wakes up and she sees the glass unicorn on her nigh stand.
- She tries to stab Billy with it, but nobody's there.
- But then Agnes grabs Lauren by her throat and she stabs her with the unicorn in her eye. (off screen)
- 6. When Kyle is killed, there is a little more blood gushing out of his head.
- 7. At the ending, there is an extra shot of Leigh standing next to a closed door in the hospital hallway and we see Billy walking past it in the shadows, foreshadowing something bad is going to happen.