Significance of vomiting after head injury

Objectives-To determine whether the presence and severity of post-traumatic vomiting can predict the risk of a skull vault fracture in adults and chil dren. Methods-Data were analysed relating to a consecutive series of 5416 patient s including children who presented to an emergency service in the United Ki ngdom during a 1 year study period with a principal diagnosis of head injur y. Characteristics studied were age, sex, speed of impact, level of conscio usness on arrival, incidence of skull fracture, and the presence and severi ty of post-traumatic vomiting. Results-The overall incidence of posttraumatic vomiting was 7% in adults an d 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 vo miting was associated with a fourfold increase in the relative risk for a s kull fracture. Nausea alone did not increase the risk of a skull fracture a nd multiple episodes of vomiting were no more significant than a single epi sode. In patients who were fully alert at presentation, post-traumatic vomi ting was associated with a twofold increase in relative risk for a skull fr acture. Conclusion-These results support the incorporation of enquiry about vomitin g into the guidelines for skull radiography. One episode of vomiting seems to be as significant as multiple episodes.