Vomiting With Head Trauma and Risk of Traumatic Brain Injury

Area of Science:

• Pediatric Emergency Medicine
• Neurotrauma Research
• Clinical Decision Rules

Background:

• Vomiting is a common symptom following head injuries in children.
• Identifying children at risk for traumatic brain injury (TBI) is crucial for appropriate management.
• Clinical decision rules (CDRs) aid in assessing TBI risk, but the role of isolated vomiting requires further clarification.

Purpose of the Study:

• To determine the prevalence of traumatic brain injuries (TBIs) in children who vomit after head injury.
• To identify specific variables within published CDRs that predict an increased risk of TBI in this pediatric population.

Main Methods:

• Secondary analysis of the Australasian Paediatric Head Injury Rule Study data.
• Vomiting characteristics were assessed and correlated with CDR predictors.
• Clinically important traumatic brain injury (ciTBI) and TBI on computed tomography (TBI-CT) were the primary outcomes.
• Isolated vomiting was defined as vomiting without other CDR predictors.

Main Results:

• Out of 19,920 children, 17.0% experienced vomiting. Vomiting was present in 44.2% of children with ciTBI and 43.2% with TBI-CT.
• Isolated vomiting was associated with a very low incidence of ciTBI (0.3%) and TBI-CT (0.6%).
• Key predictors for ciTBI with vomiting included skull fracture signs, altered mental status, headache, and abnormal behavior. Skull fracture signs and nonaccidental injury concern were significant predictors for TBI-CT.

Conclusions:

• Traumatic brain injury on computed tomography (TBI-CT) and clinically important traumatic brain injury (ciTBI) are infrequent in children with isolated vomiting after head injury.
• Observation without immediate computed tomography (CT) may be a suitable management strategy for children presenting with head injury and isolated vomiting.