Princess Margaret Hospital for Children, Perth, Australia;
Division of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Crawley, Australia.
Pediatrics. 2018 Apr;141(4). doi: 10.1542/peds.2017-3123.
To determine the prevalence of traumatic brain injuries in children who vomit after head injury and identify variables from published clinical decision rules (CDRs) that predict increased risk.
Secondary analysis of the Australasian Paediatric Head Injury Rule Study. Vomiting characteristics were assessed and correlated with CDR predictors and the presence of clinically important traumatic brain injury (ciTBI) or traumatic brain injury on computed tomography (TBI-CT). Isolated vomiting was defined as vomiting without other CDR predictors.
Of the 19 920 children enrolled, 3389 (17.0%) had any vomiting, with 2446 (72.2%) >2 years of age. In 172 patients with ciTBI, 76 had vomiting (44.2%; 95% confidence interval [CI] 36.9%-51.7%), and in 285 with TBI-CT, 123 had vomiting (43.2%; 95% CI 37.5%-49.0%). With isolated vomiting, only 1 (0.3%; 95% CI 0.0%-0.9%) had ciTBI and 2 (0.6%; 95% CI 0.0%-1.4%) had TBI-CT. Predictors of increased risk of ciTBI with vomiting by using multivariate regression were as follows: signs of skull fracture (odds ratio [OR] 80.1; 95% CI 43.4-148.0), altered mental status (OR 2.4; 95% CI 1.0-5.5), headache (OR 2.3; 95% CI 1.3-4.1), and acting abnormally (OR 1.86; 95% CI 1.0-3.4). Additional features predicting TBI-CT were as follows: skull fracture (OR 112.96; 95% CI 66.76-191.14), nonaccidental injury concern (OR 6.75; 95% CI 1.54-29.69), headache (OR 2.55; 95% CI 1.52-4.27), and acting abnormally (OR 1.83; 95% CI 1.10-3.06).
TBI-CT and ciTBI are uncommon in children presenting with head injury with isolated vomiting, and a management strategy of observation without immediate computed tomography appears appropriate.
确定呕吐是儿童头部受伤后的常见症状，并确定从已发表的临床决策规则（CDR）中预测增加风险的变量。
对澳大利亚儿科头部损伤规则研究进行二次分析。评估呕吐特征，并将其与 CDR 预测因素以及临床重要性脑损伤（ciTBI）或 CT 扫描显示脑损伤（TBI-CT）进行相关性分析。孤立性呕吐定义为呕吐而无其他 CDR 预测因素。
在纳入的 19920 名儿童中，有 3389 名（17.0%）有任何呕吐，其中 2446 名（72.2%）年龄>2 岁。在 172 名 ciTBI 患者中，有 76 名（44.2%；95%置信区间[CI]36.9%-51.7%）有呕吐，在 285 名 TBI-CT 患者中，有 123 名（43.2%；95%CI37.5%-49.0%）有呕吐。孤立性呕吐的患者中，只有 1 名（0.3%；95%CI0.0%-0.9%）ciTBI，2 名（0.6%；95%CI0.0%-1.4%）TBI-CT。采用多变量回归分析，呕吐增加 ciTBI 风险的预测因素包括颅骨骨折的迹象（比值比[OR]80.1；95%CI43.4-148.0）、精神状态改变（OR2.4；95%CI1.0-5.5）、头痛（OR2.3；95%CI1.3-4.1）和行为异常（OR1.86；95%CI1.0-3.4）。预测 TBI-CT 的其他特征包括颅骨骨折（OR112.96；95%CI66.76-191.14）、非意外损伤（OR6.75；95%CI1.54-29.69）、头痛（OR2.55；95%CI1.52-4.27）和行为异常（OR1.83；95%CI1.10-3.06）。
在呕吐为唯一症状的头部受伤儿童中，TBI-CT 和 ciTBI 并不常见，因此观察而不立即进行 CT 扫描的管理策略似乎是合适的。
