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Vomiting with head trauma and risk of traumatic brain injury

Cheek, John A.; Borland, Meredith L.; Dalziel, Stuart R.; Neutze, Jocelyn; Babl, Franz E.; Phillips, Natalie; Dalton, Sarah; Lyttle, Mark D.; Bressan, Silvia; Oakley, Ed; Hearps, Stephen J.C.; Kochar, Amit; Furyk, Jeremy; Borland, Meredith; Dalziel, Stuart; Lyttle, Mark; Babl, Franz

Authors

John A. Cheek

Meredith L. Borland

Stuart R. Dalziel

Jocelyn Neutze

Franz E. Babl

Natalie Phillips

Sarah Dalton

Mark D. Lyttle

Silvia Bressan

Ed Oakley

Stephen J.C. Hearps

Amit Kochar

Jeremy Furyk

Meredith Borland

Stuart Dalziel

Mark Lyttle

Franz Babl



Abstract

© 2018 by the American Academy of Pediatrics. OBJECTIVES: To determine the prevalence of traumatic brain injuries in children who vomit after head injury and identify variables from published clinical decision rules (CDRs) that predict increased risk. METHODS: Secondary analysis of the Australasian Paediatric Head Injury Rule Study. Vomiting characteristics were assessed and correlated with CDR predictors and the presence of clinically important traumatic brain injury (ciTBI) or traumatic brain injury on computed tomography (TBI-CT). Isolated vomiting was defined as vomiting without other CDR predictors. RESULTS: Of the 19 920 children enrolled, 3389 (17.0%) had any vomiting, with 2446 (72.2%) >2 years of age. In 172 patients with ciTBI, 76 had vomiting (44.2%; 95% confidence interval [CI] 36.9%-51.7%), and in 285 with TBI-CT, 123 had vomiting (43.2%; 95% CI 37.5%-49.0%). With isolated vomiting, only 1 (0.3%; 95% CI 0.0%-0.9%) had ciTBI and 2 (0.6%; 95% CI 0.0%-1.4%) had TBI-CT. Predictors of increased risk of ciTBI with vomiting by using multivariate regression were as follows: Signs of skull fracture (odds ratio [OR] 80.1; 95% CI 43.4-148.0), altered mental status (OR 2.4; 95% CI 1.0-5.5), headache (OR 2.3; 95% CI 1.3-4.1), and acting abnormally (OR 1.86; 95% CI 1.0-3.4). Additional features predicting TBI-CT were as follows: Skull fracture (OR 112.96; 95% CI 66.76-191.14), nonaccidental injury concern (OR 6.75; 95% CI 1.54-29.69), headache (OR 2.55; 95% CI 1.52-4.27), and acting abnormally (OR 1.83; 95% CI 1.10-3.06). CONCLUSIONS: TBI-CT and ciTBI are uncommon in children presenting with head injury with isolated vomiting, and a management strategy of observation without immediate computed tomography appears appropriate.

Journal Article Type Article
Acceptance Date Jan 1, 2018
Publication Date Apr 1, 2018
Deposit Date Feb 6, 2018
Journal Pediatrics
Print ISSN 0031-4005
Electronic ISSN 1098-4275
Publisher American Academy of Pediatrics
Peer Reviewed Peer Reviewed
Volume 141
Issue 4
Pages e20173123
DOI https://doi.org/10.1542/peds.2017-3123
Keywords vomiting, head injury, paediatric
Public URL https://uwe-repository.worktribe.com/output/872564
Publisher URL https://dx.doi.org/10.1542/peds.2017-3123
Contract Date Feb 6, 2018