Clinically important traumatic brain injury (ciTBI) is uncommon in children with minor head injuries associated with isolated vomiting, said Meredith L. Borland, MD, of the Princess Margaret Hospital for Children, Perth, Australia, and her associates.

Likewise, traumatic brain injury evident on computed tomography (TBI-CT) is rare in such cases.

In a study published in Pediatrics, 19,920 eligible children younger than 18 years were enrolled in the Australasian Paediatric Head Injury Rule Study (APHIRST); 3,389 had a history of any vomiting, and 1,006 had isolated vomiting without any other clinical decision rules predictors. Results found 76 of the 172 (44%) children with a ciTBI and 123 of the 285 (43%) children with TBI-CT had any history of vomiting. When the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) rule predictors for those with isolated vomiting – both fewer than three times (n = 662 of 1,006; 66%) and also three or more times (n = 344 of 1,006; 34%) – was applied, there was only one child with ciTBI, and there were only two children with a TBI-CT.

Within the subsample comprising 457 children younger than 2 years old with isolated vomiting out of the overall 1,006 (45%), there were none with ciTBI or TBI-CT. In the 549 (55%) children 2 years old and older with isolated vomiting, one (0.3%) had ciTBI, and two (0.6%) had TBI-CT.

In multivariate regression, signs of skull fracture, altered mental status, headache, and acting abnormally were significantly associated with ciTBI. Signs of a skull fracture, nonaccidental injury concern, headache, and acting abnormally were significantly associated with TBI-CT.

“TBI-CT is uncommon, and ciTBI is uncommon in children with minor blunt head injury when vomiting is their only sign or symptom,” Dr. Borland and her associates concluded. “In children with isolated vomiting, strategies such as observation should be considered before conducting an immediate CT scan.”

Read the full study in Pediatrics .