Association of traumatic brain injuries with vomiting in children with blunt head trauma
Peter S Dayan1, James F Holmes2, Shireen Atabaki3
1Division of Pediatric Emergency Medicine, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, NY.
Insights
Traumatic brain injuries are rare in children with minor head trauma if vomiting is the only symptom. Observation before CT scans may be suitable for many young patients.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma Research
- Clinical Pediatrics
Background:
- Vomiting is a common symptom following minor blunt head trauma in children.
- Distinguishing between isolated vomiting and vomiting with other concerning signs is crucial for diagnosing traumatic brain injury (TBI).
Purpose of the Study:
- To determine the prevalence of TBI in children experiencing isolated vomiting after minor blunt head trauma.
- To investigate the association between vomiting characteristics (timing, degree) and TBI prevalence.
Main Methods:
- Secondary analysis of a large cohort of children (<18 years) with minor blunt head trauma.
- Detailed assessment of vomiting history and characteristics during initial evaluation.
- Evaluation of TBI prevalence, including clinically important TBI and TBI on computed tomography (CT).
Main Results:
- Isolated vomiting occurred in 15.1% of children with vomiting (815/5,392).
- Clinically important TBI was rare in isolated vomiting (0.2%) vs. non-isolated vomiting (2.5%).
- TBI on CT was less common in isolated vomiting (1.7%) vs. non-isolated vomiting (6.4%).
Conclusions:
- Clinically important TBI and TBI on CT are uncommon in children with isolated vomiting after minor blunt head trauma.
- Emergency department observation may be appropriate for select children with isolated vomiting, potentially avoiding unnecessary CT scans.
Study Objective:
We aimed to determine the prevalence of traumatic brain injuries in children who vomit after minor blunt head trauma, particularly when the vomiting occurs without other findings suggestive of traumatic brain injury (ie, isolated vomiting). We also aimed to determine the relationship between the timing and degree of vomiting and traumatic brain injury prevalence.
Methods:
This was a secondary analysis of children younger than 18 years with minor blunt head trauma. Clinicians assessed for history and characteristics of vomiting at the initial evaluation. We assessed for the prevalence of clinically important traumatic brain injury and traumatic brain injury on computed tomography (CT).
Results:
Of 42,112 children enrolled, 5,557 (13.2%) had a history of vomiting, of whom 815 of 5,392 (15.1%) with complete data had isolated vomiting. Clinically important traumatic brain injury occurred in 2 of 815 patients (0.2%; 95% confidence interval [CI] 0% to 0.9%) with isolated vomiting compared with 114 of 4,577 (2.5%; 95% CI 2.1% to 3.0%) with nonisolated vomiting (difference -2.3%, 95% CI -2.8% to -1.5%). Of patients with isolated vomiting for whom CT was performed, traumatic brain injury on CT occurred in 5 of 298 (1.7%; 95% CI 0.5% to 3.9%) compared with 211 of 3,284 (6.4%; 95% CI 5.6% to 7.3%) with nonisolated vomiting (difference -4.7%; 95% CI -6.0% to -2.4%). We found no significant independent associations between prevalence of clinically important traumatic brain injury and traumatic brain injury on CT with either the timing of onset or time since the last episode of vomiting.
Conclusion:
Traumatic brain injury on CT is uncommon and clinically important traumatic brain injury is very uncommon in children with minor blunt head trauma when vomiting is their only sign or symptom. Observation in the emergency department before determining the need for CT appears appropriate for many of these children.
Related Concept Videos
01:22Pathophysiology of Vomiting
01:28Traumatic Brain Injury l: Introduction
01:30Bulimia Nervosa
01:15Equilibrium and Balance