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Can we safely give ondansetron to children with vomiting after a head injury?
  1. Christopher Lowry1,
  2. Peter McAlister1,
  3. Fiona Wallace1,
  4. Richard Fallis2,
  5. Stephen Mullen1
  1. 1 Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
  2. 2 Library for Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, UK
  1. Correspondence to Dr Christopher Lowry, Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast BT12 6BA, UK; christopher.lowry{at}

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A 3-year-old boy attends the emergency department (ED) following a head injury, falling from standing onto a tiled floor. He had no loss of consciousness and no seizure activity but vomited once at home. Examination notes a 2×1 cm firm swelling to his occiput but no evidence of basal skull fracture. He has a normal neurological examination and you have no concerns from a safeguarding perspective. The patient goes on to have another vomit, and the nurse asks if you can consider giving ondansetron.

You wonder if administering ondansetron may delay diagnosing an intracranial injury.

Structure clinical question

In children with a minor head injury, as defined by NICE criteria (population), does administration of ondansetron (intervention) compared with no ondansetron (control) delay diagnosis of intracranial injury (outcome)?


MEDLINE, Web of Science, Scopus and the Cochrane library were searched from 1 January 1980 to present (February 2020). Search terms included (Ondansetron OR Zofran) AND (craniocerebral trauma OR minor head injury) AND (all child (0–18 years). Inclusion criteria: 0–18 years, English language and original articles, including conference papers, after 1980. The literature search returned 17 studies in total. These were reviewed, by title and abstract, where two papers were deemed relevant for review. These two papers were subsequently reviewed in full, and are summarised in table 1. …

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  • Contributors CL, SM, PM and FW contributed to the literature review and manuscript production. RF performed the literature search.

  • 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.

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

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