I liked this movie but.. *spoilers*

Unfortunately, like most people I think you're missing the point of the movie. It really is an intelligent ghost story about two friends forever divided by an unfortunate tragedy.

As you know when the game turns real and as each of the characters are killed they're turned into ghosts and any trace of them ever being alive is erased just like in the game's rhyme. Reality, or Sandy's perception of reality rather, is subsequently altered to prevent the introduction of the paradox. You're looking at it the wrong way because the acts of the brother wasn't a pivotal plot progression, but rather a secondary subplot.

So, you're wondering why when Sandy is taken to the hospital and after the brother dies then why are we still at the hospital? It's because Sandy was always in the hospital and never left the place. While this point and other plot points alluding to the thematic messages and the multiple subplots embedded within the context of the story are never so clearly explained, you have to look at the context of the events to understand what is really happening. Sandy had been deteriorating for a long time and had been disturbed since the incident with Angela. Her mental health had been declining, probably as a result of a nervous breakdown from her repressed sense of guilt from what she had done to Angela, which is why her parents had her committed to the hospital. You see her being committed and although you don't actually see her being sent to the hospital until towards the end of the movie, Sandy had been in the hospital from the beginning of the movie. You see all the events that took place throughout the movie never took place in the physical world -- it was all an internal struggle for Sandy.

You will understand better when you grasp the second point better.

I'm glad that the director and crew didn't bring the characters back to tie up all the events of the movie and cheat the audience with a cliche happy ending. It would have effectively undone the major theme of the movie which was retribution with a sense of paranormal justice. The movie wasn't unresolved with everyone else. They weren't dead and they didn't come back either because they never had existed. Angela and Sandy had invented the other friends, a figment of their imaginations if you will.

How do I know this? There were many hints throughout the movie and the movie leaves it up to you to study the events on a deeper level to piece the clues together. The story is really just about Sandy and Angela and the conflict which separates them. Sandy had been Angela's best friend and she betrayed her.

The first clue was the original playing of the game. In the first flashback you see only Sandy and Angela playing the game, note none of the other kids are around. In fact you don't the other characters playing the game as a group of kids in a flashback until three quarters of the way through the movie. The movie wants you to believe that all of the characters had been friends since childhood, but they are purposely misleading to setup an implied plot twist, which is the other kids weren't real. If they had known each other since childhood then why is it in the first series of flashbacks you don't see the other kids?

The second clue is a piece of dialogue spoken by Angela in the fist flashback: "Sister Dolores says if my faith (important keyword) is strong enough I can have all the friends I want, but I only want you." So, you should be asking yourself why would she need faith, an intangible metaphysical concept, to make friends? This is a verbal hint that the other kids had been fabricated, probably to make the game more interesting.

The third clue is the opening sequence of the movie. You see only Sandy running and screaming through the graveyard with paint on her face, again note the complete lack of the other kids.

The fourth clue is the flashback when you find out what happened to Angela. After she has her seizure and the nun opens the door to the convent to find Angela collapsed she never actually saw the other kids. The other kids disappeared way too quickly. When Sandy ran away she was right behind the other kids as they fled the convent, but seconds later when you see only Sandy running through the cemetery the other kids are gone. Where did they go? Logically speaking, they couldn't have gone far since the convent and the graveyard are right next to each other, but you only see Sandy running through the graveyard by herself thus coming full circle to the opening sequence.

The fifth clue is when Sandy speaks Eli's name from the hospital bed and the black guy, whom you originally believed to be the Dean of Admissions to Stanford but in reality is a psychiatrist, asks if Eli is one of her friends. The parent's response is: "Sandy doesn't have any friends." The big hint that what we have been seeing through Sandy's point of view isn't based in the real world is because of the black doctor. Ever stopped to wonder why a Dean of Admissions for a college would be at the hospital after Sandy's breakdown shining a light in her eyes? When the characters had died off the world hadn't changed, but instead Sandy was being pulled from her disillusionment coming closer to the real world and the truth, which was in reality she didn't have any friends other than Angela. So the whole movie the ghost of Angela is breaking down Sandy's disillusioned reality killing off her invented friends and breaking her down mentally. It's an exploratory internal journey as you see Sandy's psyche unravel.

The sixth clue is the confrontation between Sandy and Angela on the hospital rooftop. When Sandy finally admits to Angela and herself what really happened and taking responsibility. She says, "I know what I did to you," not "what we did to you." This is the biggest hint that the other characters had never been real because neither Angela nor Sandy acknowledge that the other kids had any part in what happened to Angela which is why you see only Sandy running through the graveyard by herself in the opening sequence, why the nun never saw the other kids when Angela collapses, and why Sandy's parents admit she doesn't have any friends.

The Seventh clue is when Angela awakens finally. She has a very grievous and sad expression on her face when she comes out of the coma because she, and only she, knows what happened. She feels sad because she knows her awakening means Sandy will have fallen into a coma, but it also signifies while she feels the pain of the loss of her friend it also means that a terrible injustice has been corrected. Then in the final frame of that scene Angela makes an ever so slight smile...

Then you see Sandy and only Sandy in a coma in a hospital bed -- the other characters were never real and had been destroyed as Sandy slipped out of her disillusionment. As I said before the movie had been an internal journey. The two friends had been fighting it out on "the other side".

The final clue about the metaphysical confrontation is hinted at by the empty hospital. Notice when Sandy turns off Angela's life support and the EKG flatlines not a single doctor or nurse comes running into the room. Also, when Sandy is running through the corridors banging on doors and screaming for help there isn't anyone around. There's not a nurse at the nurse station, you don't see any doctors, there isn't a security guard or other patients -- the hospital is completely and wholly deserted except for Sandy and the ghosts. This is to symbolize that the conflict with the ghosts is not based in th real world but taking place on some metaphysical realm instead.

Then there is the logical deduction part. If you saw landscape shots of the hospital before Sandy was carted in it was a pretty tall building and if Sandy had fallen from the rooftop in the real world then should would have suffered a fate much worse than a coma. She would have died or been paralyzed. The rooftop confrontation happened on the other side as Angela and Sandy battle it out for the last time and in the end it was Angela who emerged victorious. Angela smiles when she awakes because she had beaten Sandy and won the game finally.