Traumatic Brain Injury Risk After Head Injury and Vomiting

Abstract

Research Article| July 01 2018 Traumatic Brain Injury Risk After Head Injury and Vomiting AAP Grand Rounds (2018) 40 (1): 4. https://doi.org/10.1542/gr.40-1-4 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Traumatic Brain Injury Risk After Head Injury and Vomiting. AAP Grand Rounds July 2018; 40 (1): 4. https://doi.org/10.1542/gr.40-1-4 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: craniocerebral trauma, traumatic brain injuries, vomiting Source: Borland ML, Dalziel SR, Phillips N, et al. Vomiting with head trauma and risk of traumatic brain injury. Pediatrics. 2018; 141(4): e20173123; doi: https://doi.org/10.1542/peds.2017-3123Google Scholar Investigators from multiple institutions conducted a secondary analysis of data collected as part of a prospective observational study about the accuracy of clinical decision rules for pediatric head injuries. The aim of the secondary analysis was to understand the prevalence of traumatic brain injuries (TBI) in children with head injury who present with isolated vomiting. Study participants were eligible if they were <18 years old and presented to a participating ED with head injury. Participants had clinical data collected by the treating clinician before neuroimaging, which included history and physical exam elements present on existing clinical decision rules for head injury (eg, loss of consciousness, altered mental status, and high-risk mechanism of injury). The primary exposure was the presence of isolated vomiting, defined as vomiting in the absence of any other sign or symptom of head injury and categorized as (a) any frequency of vomiting in participants <2 years old, (b) any frequency of vomiting in participants ≥2 years old, (c) vomiting <3 times in child of any age, and (d) vomiting ≥3 times in child of any age. The primary outcomes were clinically important TBI (ciTBI), defined as TBI resulting in death, intubation for >24 hours, neurosurgery or hospital admission of ≥2 nights, and TBI on CT (TBI-CT), defined as the presence on CT of intracranial hemorrhage or contusion, cerebral edema, diffuse axonal injury, depressed skull fracture, or related findings. Investigators determined the rates of ciTBI and TBI-CT among those with isolated vomiting. Of 19,920 participants, 1,006 (5%) had isolated vomiting, 172 had ciTBI (0.8%), and 285 (1.4%) had TBI-CT. The frequency of ciTBI or TBI-CT in participants <2 years old with any frequency of isolated vomiting was 0% for both ciTBI and TBI-CT. The frequency of ciTBI or TBI-CT in participants ≥2 years old with any frequency of isolated vomiting was 0.3% (1 out of 549) and 0.6% (2 out of 549), respectively. The frequency of ciTBI or TBI-CT among those of any age with <3 times of isolated vomiting was 0% for both ciTBI and TBI-CT. The frequency of ciTBI or TBI-CT among those of any age with ≥3 times of isolated vomiting was 0.3% (1 out of 344) and 0.6% (2 out of 344), respectively. The authors conclude that TBI in a child who presents with a head injury and isolated vomiting is rare. Dr Stevenson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Thankfully, there are several published prediction rules designed to assist clinicians in predicting the likelihood of ciTBI in children who sustain a head trauma (see related article AAP Grand Rounds, 2010:23[1]:1).1,2 These rules minimize CT use and subsequent exposure of injured children to ionizing... You do not currently have access to this content.