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Objectives

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 posttraumatic 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. (J Neurol Neurosurg Psychiatry 1999;66:470-473)

Head injury outcome is influenced by the initial insult and the various pathophysiological changes that take place in the posttraumatic phase, some of which may be amenable to intervention. Appropriate measures taken during initial emergency department management and subsequently in the intensive therapy unit can significantly improve outcome. The primary goal is to limit secondary brain injury. Early imaging, rather than admission and observation for neurological deterioration, reduces the time to the detection of life-threatening complications. This paper discusses the current management of severe head injury, some prognostic indicators and methods used to rule out an associated spinal injury.