Significance of vomiting after head injury.
OBJECTIVE
To determine whether the presence and severity of post-traumatic vomiting can predict the risk of a skull vault fracture in adults and children.


METHODS
Data were analysed relating to a consecutive series of 5416 patients including children who presented to an emergency service in the United Kingdom during a 1 year study period with a principal diagnosis of head injury. Characteristics studied were age, sex, speed of impact, level of consciousness on arrival, incidence of skull fracture, and the presence and severity of post-traumatic vomiting.


RESULTS
The overall incidence of post-traumatic vomiting was 7% in adults and 12% in children. In patients with a skull fracture the incidence of post-traumatic vomiting was 28% in adults and 33% in children. Post-traumatic vomiting was associated with a fourfold increase in the relative risk for a skull fracture. Nausea alone did not increase the risk of a skull fracture and multiple episodes of vomiting were no more significant than a single episode. In patients who were fully alert at presentation, post-traumatic vomiting was associated with a twofold increase in relative risk for a skull fracture.


CONCLUSIONS
These results support the incorporation of enquiry about vomiting into the guidelines for skull radiography. One episode of vomiting seems to be as significant as multiple episodes.
Nee
P A
PA
Accident and Emergency Department, Whiston Hospital, Merseyside, UK.
Hadfield
J M
JM
Yates
D W
DW
Faragher
E B
EB
D000328:Adult; D002648:Child; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D008297:Male; D009325:Nausea / Q000453:epidemiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011859:Radiography; D012044:Regression Analysis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D006113:United Kingdom / Q000453:epidemiology; D014839:Vomiting / Q000453:epidemiology*