Can we safely give ondansetron to children with vomiting after a head injury?

A 3-year-old boy attends the emergency department (ED) following a head injury, falling from standing onto a tiled floor. He had no loss of consciousness and no seizure activity but vomited once at home. Examination notes a 2×1 cm firm swelling to his occiput but no evidence of basal skull fracture. He has a normal neurological examination and you have no concerns from a safeguarding perspective. The patient goes on to have another vomit, and the nurse asks if you can consider giving ondansetron. You wonder if administering ondansetron may delay diagnosing an intracranial injury. In children with a minor head injury, as defined by NICE criteria (population), does administration of ondansetron (intervention) compared with no ondansetron (control) delay diagnosis of intracranial injury (outcome)? MEDLINE, Web of Science, Scopus and the Cochrane library were searched from 1 January 1980 to present (February 2020). Search terms included (Ondansetron OR Zofran) AND (craniocerebral trauma OR minor head injury) AND (all child (0–18 years). Inclusion criteria: 0–18 years, English language and original articles, including conference papers, after 1980. The literature search returned 17 studies in total. These were reviewed, by title and abstract, where two papers were deemed relevant for review. These two papers were subsequently reviewed in full, and are summarised in table 1. View this table: Table 1 Summary of …