Vomiting With Head Trauma and Risk of Traumatic Brain Injury

Author:

Borland Meredith L.12,Dalziel Stuart R.34,Phillips Natalie56,Dalton Sarah7,Lyttle Mark D.8910,Bressan Silvia811,Oakley Ed81213,Hearps Stephen J.C.8,Kochar Amit14,Furyk Jeremy15,Cheek John A.812,Neutze Jocelyn16,Babl Franz E.81213,

Affiliation:

1. Princess Margaret Hospital for Children, Perth, Australia;

2. Division of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Crawley, Australia;

3. Starship Children’s Health, Auckland, New Zealand;

4. Liggins Institute, University of Auckland, Auckland, New Zealand;

5. Lady Cilento Children’s Hospital, South Brisbane, Australia;

6. Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia;

7. The Children’s Hospital at Westmead, Sydney, Australia;

8. Murdoch Children’s Research Institute, Melbourne, Australia;

9. Bristol Royal Hospital for Children, Bristol, United Kingdom;

10. Academic Department of Emergency Care, University of the West of England, Bristol, Bristol, United Kingdom;

11. Department of Women’s and Children’s Health, University of Padova, Padova, Italy;

12. The Royal Children’s Hospital, Melbourne, Australia;

13. Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia;

14. Women’s and Children’s Hospital, North Adelaide, Australia;

15. The Townsville Hospital, Townsville, Australia; and

16. Kidz First Children’s Hospital, Auckland, New Zealand

Abstract

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.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3