Observation Before CT in Peds Head Trauma
(HealthDay News) — Children with minor blunt head trauma who present with isolated vomiting may not need a computed tomography (CT) scan to look for traumatic brain injury, according to research published online Feb. 21 in the Annals of Emergency Medicine.
Peter S. Dayan, MD, of the Columbia University College of Physicians and Surgeons in New York City, and colleagues conducted a secondary analysis of children aged ≤18 years with minor blunt head trauma. The researchers assessed history of characteristics of vomiting at the initial evaluation and prevalence of traumatic brain injury on CT.
The researchers found that clinically important traumatic brain injury occurred in two of 815 patients (0.2%; 95% confidence interval [CI], 0 to 0.9%) with isolated vomiting versus 114 of 4,577 patients (2.5%; 95% CI, 2.1–3.0 percent) with vomiting accompanied by other signs and symptoms. Among patients who received CT, traumatic brain injury was detected in five of 298 patients (1.7%; 95% CI, 0.5–3.9%) with isolated vomiting versus 211 of 3,284 patients (6.4%; 95% CI, 5.6–7.3%) with non-isolated vomiting.
"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," the authors write. "Observation in the emergency department before determining the need for CT appears appropriate for many of these children."