Assessment of the predictive value of vomiting versus physical examination for a CT scan in children with head injury

• Pediatric head injury is a frequent cause of emergency department visits. • Vomiting is common post-trauma but has uncertain value for predicting brain injury. • Retrospective analysis of 655 children aged 1–18 years (2019–2021). • Abnormal physical findings were associated with predicted pathological CT findings. • Substantial imitations prevent definitive conclusions about observation safety. Head injuries are common in children of all ages. While most are minor and do not require intervention, severe cases remain a leading cause of mortality and disability. Identifying minor head trauma with a significant risk of intracranial injury is challenging. Vomiting is a frequent symptom after pediatric head injury, but its predictive value for intracranial pathology remains uncertain. This study investigates the relationship between vomiting and pathological CT findings in children with head injury. We conducted a retrospective single-center study of 655 children aged 1-18 with minor head injuries who presented to the pediatric emergency department (2019-2021). Physical examination abnormalities were analyzed as a composite variable. Logistic regression identified predictors of pathological CT findings among children with vomiting. Vomiting occurred in 30.9% of patients. CT rates and pathological findings were similar between children with vomiting (41.1% scanned, 22.9% with pathology) and those without vomiting (38.6% scanned, 21.1% with pathology). Among children with vomiting who underwent CT, composite physical examination abnormalities predicted pathological findings (OR=14.2, 95% CI: 1.75–114.68). However, these variable combined heterogeneous findings from minor scalp hematomas to neurological deficits, limiting interpretation. Vomiting alone was not associated with increased pathological CT findings. Composite physical examination abnormalities predicted CT pathology in children with vomiting. Major limitations include the composite nature of the variable, lack of CT or follow-up in 60.5% of patients, incomplete vomiting data, and selection bias in imaging. Prospective studies with validated criteria and systematic follow-up are needed to confirm observation safety.