Nee P A, Hadfield J M, Yates D W, Faragher E B
Accident and Emergency Department, Whiston Hospital, Merseyside, UK.
J Neurol Neurosurg Psychiatry. 1999 Apr;66(4):470-3. doi: 10.1136/jnnp.66.4.470.
To determine whether the presence and severity of post-traumatic vomiting can predict the risk of a skull vault fracture in adults and children.
Data were analysed relating to a consecutive series of 5416 patients including children who presented to an emergency service in the United Kingdom during a 1 year study period with a principal diagnosis of head injury. Characteristics studied were age, sex, speed of impact, level of consciousness on arrival, incidence of skull fracture, and the presence and severity of post-traumatic vomiting.
The overall incidence of post-traumatic vomiting was 7% in adults and 12% in children. In patients with a skull fracture the incidence of post-traumatic vomiting was 28% in adults and 33% in children. Post-traumatic vomiting was associated with a fourfold increase in the relative risk for a skull fracture. Nausea alone did not increase the risk of a skull fracture and multiple episodes of vomiting were no more significant than a single episode. In patients who were fully alert at presentation, post-traumatic vomiting was associated with a twofold increase in relative risk for a skull fracture.
These results support the incorporation of enquiry about vomiting into the guidelines for skull radiography. One episode of vomiting seems to be as significant as multiple episodes.
确定创伤后呕吐的存在及严重程度是否能预测成人和儿童颅骨骨折的风险。
对一系列连续的5416例患者的数据进行分析，这些患者包括在为期1年的研究期间因头部受伤为主诊断而就诊于英国一家急诊机构的儿童。所研究的特征包括年龄、性别、撞击速度、到达时的意识水平、颅骨骨折的发生率以及创伤后呕吐的存在及严重程度。
成人创伤后呕吐的总体发生率为7%，儿童为12%。在颅骨骨折患者中，成人创伤后呕吐的发生率为28%，儿童为33%。创伤后呕吐与颅骨骨折的相对风险增加四倍相关。单纯恶心并未增加颅骨骨折的风险，多次呕吐发作与单次发作相比并无更显著影响。在就诊时意识完全清醒的患者中，创伤后呕吐与颅骨骨折的相对风险增加两倍相关。
这些结果支持将呕吐询问纳入颅骨X线检查指南。单次呕吐发作似乎与多次发作同样重要。
