title: Association of traumatic brain injuries with vomiting in children with blunt head trauma.
abstract: OBJECTIVE
  We aimed to determine the prevalence of traumatic brain injuries in children who vomit after minor blunt head trauma, particularly when the vomiting occurs without other findings suggestive of traumatic brain injury (ie, isolated vomiting). We also aimed to determine the relationship between the timing and degree of vomiting and traumatic brain injury prevalence.
  
  
  METHODS
  This was a secondary analysis of children younger than 18 years with minor blunt head trauma. Clinicians assessed for history and characteristics of vomiting at the initial evaluation. We assessed for the prevalence of clinically important traumatic brain injury and traumatic brain injury on computed tomography (CT).
  
  
  RESULTS
  Of 42,112 children enrolled, 5,557 (13.2%) had a history of vomiting, of whom 815 of 5,392 (15.1%) with complete data had isolated vomiting. Clinically important traumatic brain injury occurred in 2 of 815 patients (0.2%; 95% confidence interval [CI] 0% to 0.9%) with isolated vomiting compared with 114 of 4,577 (2.5%; 95% CI 2.1% to 3.0%) with nonisolated vomiting (difference -2.3%, 95% CI -2.8% to -1.5%). Of patients with isolated vomiting for whom CT was performed, traumatic brain injury on CT occurred in 5 of 298 (1.7%; 95% CI 0.5% to 3.9%) compared with 211 of 3,284 (6.4%; 95% CI 5.6% to 7.3%) with nonisolated vomiting (difference -4.7%; 95% CI -6.0% to -2.4%). We found no significant independent associations between prevalence of clinically important traumatic brain injury and traumatic brain injury on CT with either the timing of onset or time since the last episode of vomiting.
  
  
  CONCLUSIONS
  Traumatic brain injury on CT is uncommon and clinically important traumatic brain injury is very uncommon in children with minor blunt head trauma when vomiting is their only sign or symptom. Observation in the emergency department before determining the need for CT appears appropriate for many of these children.
authors.affiliation: Division of Pediatric Emergency Medicine, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, NY. Electronic address: psd6@columbia.edu.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.affiliation: Department of Emergency Medicine, University of California Davis Medical Center, University of California, Davis School of Medicine, Davis, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.affiliation: Departments of Pediatrics and Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC.
authors.forename: Shireen
authors.initials: S
authors.lastname: Atabaki
authors.affiliation: Division of Emergency Medicine, Helen DeVos Children's Hospital, Michigan State, Grand Rapids, MI.
authors.forename: John
authors.initials: J
authors.lastname: Hoyle
authors.affiliation: Departments of Pediatrics and Emergency Medicine, New York University School of Medicine, New York, NY.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tunik
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Richard
authors.initials: R
authors.lastname: Lichenstein
authors.affiliation: Division of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Alpern
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Michelle
authors.initials: M
authors.lastname: Miskin
authors.affiliation: Department of Emergency Medicine, University of California Davis Medical Center, University of California, Davis School of Medicine, Davis, CA; Department of Pediatrics, University of California Davis Medical Center, University of California, Davis School of Medicine, Davis, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D002675:Child, Preschool; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008297:Male; D059906:Neuroimaging; D015995:Prevalence; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology*