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Clinical bottom line
In the case of isolated vomiting, a period of observation is a safe option and avoids ionising radiation (grade B).
It is worth remembering that in the adult population isolated vomiting is a risk factor for clinically important traumatic brain injury and traumatic brain injury on CT and CT head scans should be considered for teenage ‘children’ sooner than in younger children (grade D).
You are working in a children’s emergency department where you assess a child aged 22 months who has had a minor head injury (witnessed fall onto a concrete surface, no loss of consciousness, Glasgow Coma Score 15/15 and normal neurological examination). She has now vomited on four separate episodes including while under observation. The emergency department consultant would like to perform a CT head, however, you are concerned about the radiation exposure in a young child who appears to have no other clinical signs of a traumatic brain injury (TBI). When talking to the parents you want to discuss the risks of i) CT head versus ii) prolonged period of observation.
Structured clinical question
In children who sustain a minor head injury (TBI) where isolated vomiting is the only symptom (patient), is a period of observation (intervention) compared with a CT head (comparison) as good at predicting intracranial injury (outcome)?
In March 2019, articles written in the English language on Medline (1946 to present) and EMBASE (1974 to present) were searched via the OVID search tool. The search terms used were: (head injury …
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