Vomiting Is a Poor Predictor of Intracranial Injury in Pediatric Head Trauma

Katherine Bakes, MD

And in children with isolated vomiting, the risk for intracranial injuries was low.

In a secondary analysis of patients presenting with blunt head trauma to centers in the Pediatric Emergency Care Applied Research Network (PECARN), investigators evaluated whether isolated vomiting is a predictor of intracranial injuries. Isolated vomiting was defined two ways: (1) vomiting in a patient acting normally and without loss of consciousness, altered mental status, skull fracture, scalp trauma, headache, seizure, neurologic deficits, or amnesia (extensive definition); (2) vomiting in the absence of all other criteria of the PECARN head injury rules (NEJM JW Emerg Med Sep 25 2009). Clinically important brain injury was defined as injury resulting in death, a neurosurgical procedure, intubation, or hospitalization for two or more nights.

Of 5392 children with head trauma and vomiting, 815 (15%; median age, 2 years) met the extensive definition for isolated vomiting, and of these, 2 (0.2%) had clinically important injuries (hospitalization for 2 or more nights). Both cases had severe mechanisms of injury (as defined in the PECARN rules). Among patients who met the PECARN-based definition of isolated vomiting, none of 567 patients aged <2 years and 10 of 1501 patients (0.7%) aged 2 to 18 years had clinically important brain injuries. Five patients required neurosurgery; all had mild to moderate headaches and vomited within 1 hour of injury, and three had scalp hematomas. Surprisingly, in multivariable analyses of children with any vomiting (isolated or otherwise), fewer episodes of vomiting were associated with increased risk for intracranial injury but not clinically important brain injury.

Citation(s):

Dayan PS et al. Association of traumatic brain injuries with vomiting in children with blunt head trauma. Ann Emerg Med 2014 Jun; 63:657.