You are here

Article Text

Article menu
Download PDFPDF
Archimedes
Use of CT in children with minor head injuries with isolated vomiting
  1. Helen Newsome
  1. Sheffield Children’s NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Helen Newsome, Sheffield Children's NHS Foundation Trust, Sheffield S10 2TH, UK; helennewsome{at}nhs.net

http://dx.doi.org/10.1136/archdischild-2019-317949

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    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).

    Scenario

    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)?

    Search

    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 …

    View Full Text

    Footnotes

    • Contributors HN conceived the idea for this article, wrote and reviewed the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    Linked Articles