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Prehospital nausea and vomiting after trauma: Prevalence, risk factors, and development of a predictive scoring system

Easton, Ruth BMed; Bendinelli, Cino MD; Sisak, Krisztian MD; Enninghorst, Natalie MD; Balogh, Zsolt MD, PhD

Journal of Trauma and Acute Care Surgery: May 2012 - Volume 72 - Issue 5 - p 1249–1254
doi: 10.1097/TA.0b013e318249668e
Original Articles

BACKGROUND: Nausea and vomiting are common problems in trauma patients and potentially dangerous during trauma resuscitation. These symptoms are present in up to 10% of ambulance patients, but their prevalence in trauma patients is largely unknown. The aim of this study was to determine the prevalence of prehospital nausea and vomiting in trauma patients and evaluate antiemetic usage.

METHODS: Prospective, cohort study of trauma resuscitation patients transported by ambulance to a major trauma centre. Patients with hemodynamic instability (systolic blood pressure <90, heart rate >120) or Glasgow Coma Scale score <14 on arrival were excluded. Nausea, vomiting, and antiemetic use were recorded.

RESULTS: Convenience sample of 196 trauma resuscitation patients (68% men; age, 42 ± 18 years, mean Injury Severity Score 8 ± 7) were interviewed over the 5-month study period, of a total 369 admitted trauma patients (53%). Seventy-five (38%) patients reported some degree of nausea, 57 (29%) moderate or severe nausea, and 15 (8%) vomited. Older age and female gender were associated with vomiting (p < 0.01). Seventy-nine patients (40%) received a prophylactic antiemetic. Of these, four became nauseous (5%), compared with 71 of 117 (61%) for patients not given an antiemetic (p < 0.0001).

CONCLUSIONS: Prehospital nausea and vomiting are more common in our cohort of trauma patients than the reported rates in the literature for nontrauma patients transported to hospital by ambulance. Only 40% of patients receive prophylactic antiemetics, but those patients are less likely to develop symptoms.

LEVEL OF EVIDENCE: V, epidemiological study.

Newcastle, Australia

From the Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.

Submitted: September 23, 2011, Revised: November 16, 2011, Accepted: January 3, 2012.

The abstract for this work has been presented in electronic poster format at the Royal Australasian College of Surgeons Annual Scientific Congress, May 2011.

Address for reprints: Zsolt J. Balogh, MD, PhD, FRACS, Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW 2310, Australia; email:

© 2012 Lippincott Williams & Wilkins, Inc.