Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Apr;66(4):470–473. doi: 10.1136/jnnp.66.4.470

Significance of vomiting after head injury

P Nee 1, J Hadfield 1, D Yates 1, E Faragher 1
PMCID: PMC1736317  PMID: 10201418

Abstract

OBJECTIVES—To determine whether the presence and severity of post-traumatic vomiting can predict the risk of a skull vault fracture in adults and children.
METHODS—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.
RESULTS—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. 
CONCLUSION—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.



Full Text

The Full Text of this article is available as a PDF (83.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ando S., Otani M., Moritake K. Clinical analysis of post-traumatic vomiting. Acta Neurochir (Wien) 1992;119(1-4):97–100. doi: 10.1007/BF01541790. [DOI] [PubMed] [Google Scholar]
  2. Bell R. S., Loop J. W. The utility and futility of radiographic skull examination for trauma. N Engl J Med. 1971 Feb 4;284(5):236–239. doi: 10.1056/NEJM197102042840504. [DOI] [PubMed] [Google Scholar]
  3. Boulis Z. F., Dick R., Barnes N. R. Head injuries in children--aetiology, symptoms, physical findings and x-ray wastage. Br J Radiol. 1978 Nov;51(611):851–854. doi: 10.1259/0007-1285-51-611-851. [DOI] [PubMed] [Google Scholar]
  4. Chan K. H., Yue C. P., Mann K. S. The risk of intracranial complications in pediatric head injury. Results of multivariate analysis. Childs Nerv Syst. 1990 Jan;6(1):27–29. doi: 10.1007/BF00262262. [DOI] [PubMed] [Google Scholar]
  5. Duus B. R., Boesen T., Kruse K. V., Nielsen K. B. Prognostic signs in the evaluation of patients with minor head injury. Br J Surg. 1993 Aug;80(8):988–991. doi: 10.1002/bjs.1800800817. [DOI] [PubMed] [Google Scholar]
  6. Gorman D. F. The utility of post-traumatic skull X-rays. Arch Emerg Med. 1987 Sep;4(3):141–150. doi: 10.1136/emj.4.3.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Guidelines for initial management after head injury in adults. Suggestions from a group of neurosurgeons. Br Med J (Clin Res Ed) 1984 Mar 31;288(6422):983–985. doi: 10.1136/bmj.288.6422.983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hashimoto I., Nemoto S., Sano K. Hyperexcitable state of the brainstem in children with post-traumatic vomiting as evidenced by brainstem auditory-evoked potentials. Neurol Res. 1984 Mar-Jun;6(1-2):81–84. doi: 10.1080/01616412.1984.11739670. [DOI] [PubMed] [Google Scholar]
  9. Hugenholtz H., Izukawa D., Shear P., Li M., Ventureyra E. C. Vomiting in children following head injury. Childs Nerv Syst. 1987;3(5):266–270. doi: 10.1007/BF00271820. [DOI] [PubMed] [Google Scholar]
  10. Jones J. J., Jeffreys R. V. Relative risk of alternative admission policies for patients with head injuries. Lancet. 1981 Oct 17;2(8251):850–853. doi: 10.1016/s0140-6736(81)91114-4. [DOI] [PubMed] [Google Scholar]
  11. Lee S. T., Liu T. N., Wong C. W., Yeh Y. S., Tzaan W. C. Relative risk of deterioration after mild closed head injury. Acta Neurochir (Wien) 1995;135(3-4):136–140. doi: 10.1007/BF02187757. [DOI] [PubMed] [Google Scholar]
  12. Masters S. J., McClean P. M., Arcarese J. S., Brown R. F., Campbell J. A., Freed H. A., Hess G. H., Hoff J. T., Kobrine A., Koziol D. F. Skull x-ray examinations after head trauma. Recommendations by a multidisciplinary panel and validation study. N Engl J Med. 1987 Jan 8;316(2):84–91. doi: 10.1056/NEJM198701083160205. [DOI] [PubMed] [Google Scholar]
  13. Mendelow A. D., Teasdale G., Jennett B., Bryden J., Hessett C., Murray G. Risks of intracranial haematoma in head injured adults. Br Med J (Clin Res Ed) 1983 Oct 22;287(6400):1173–1176. doi: 10.1136/bmj.287.6400.1173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Miller J. D., Jones P. A. The work of a regional head injury service. Lancet. 1985 May 18;1(8438):1141–1144. doi: 10.1016/s0140-6736(85)92442-0. [DOI] [PubMed] [Google Scholar]
  15. Nee P. A., Hadfield J. M., Yates D. W. Biomechanical factors in patient selection for radiography after head injury. Injury. 1993 Aug;24(7):471–475. doi: 10.1016/0020-1383(93)90153-w. [DOI] [PubMed] [Google Scholar]
  16. Nee P. A., Phillips B. M., Bannister C. M. Extradural haematoma in a child after an apparently mild head injury. BMJ. 1993 Jun 19;306(6893):1665–1666. doi: 10.1136/bmj.306.6893.1665. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Savastio G., Golfieri R., Pastore Trossello M., Venturoli L. Trauma cranico: predittività dei sintomi di presentazione come screening per lo studio radiologico. Radiol Med. 1991 Dec;82(6):769–775. [PubMed] [Google Scholar]
  18. Swann I. J., MacMillan R., Strong I. Head injuries at an inner city accident and emergency department. Injury. 1981 Jan;12(4):274–278. doi: 10.1016/0020-1383(81)90200-x. [DOI] [PubMed] [Google Scholar]
  19. Teasdale G. M., Murray G., Anderson E., Mendelow A. D., MacMillan R., Jennett B., Brookes M. Risks of acute traumatic intracranial haematoma in children and adults: implications for managing head injuries. BMJ. 1990 Feb 10;300(6721):363–367. doi: 10.1136/bmj.300.6721.363. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES