Publication related to RSI or an RSI staff member
Association between ondansetron use and symptom persistence in children with concussions: A 5P substudy.
OBJECTIVE: Ondansetron is increasingly administered to children suffering from concussion-associated nausea/vomiting. We examined the association between ondansetron administration and post-concussion symptoms in children at 1 week and 1 month following the concussion. METHODS: This was a secondary analysis of data collected prospectively in a cohort study conducted in nine pediatric emergency departments (EDs) (5P study). Participants were children ages between 5 and 17.99 years who sustained a concussion in the previous 48 hours. For the current study, only 5P participants who reported nausea and/or vomiting in the ED were eligible. The exposure of interest was ondansetron administration; the comparison group included all other participants. The primary outcome was an increase in at least three symptoms of the Post-Concussion Symptom Inventory score at 1 week and 1 month following trauma. RESULTS: Among the 3,063 children included in the 5P study, 1805 (59%) reported nausea and provided data at 1 week and/or 1 month. Among them, 132 (7%) received ondansetron. Multivariable logistic regression adjusted for confounders did not show an association between ondansetron use and the risk of persistent post-concussion symptoms at 1 week (OR: 1.13 [95% CI: 0.86-1.49]), but it was associated with a higher risk at 1 month (OR: 1.33 [95% CI: 1.05-1.97]). CONCLUSION: In children presenting to the ED with an acute concussion, ondansetron use was associated with a higher risk of persistent post-concussion symptoms at 1 month. Although this may be related to the limitations of the design, it highlights the importance of evaluating this association using a randomized clinical trial.
Authors
- Gravel, Jocelyn, Gravel J, *Department of Pediatrics,CHU Sainte-Justine,Université de Montréal,Montréal,QC.
- Boutis, Kathy, Boutis K, †Department of Pediatrics,The Hospital for Sick Children,University of Toronto,Toronto,ON.
- Tang, Ken, Tang K, ‡Clinical Research Unit,Children's Hospital of Eastern Ontario Research Institute,Ottawa,ON.
- Beauchamp, Miriam H, Beauchamp MH, ¶Department of Psychology,Université de Montréal,Montréal,QC.
- Freedman, Stephen B, Freedman SB, **Department of Pediatrics,Alberta's Children Hospital,Calgary,AB.
- Dubrovsky, Alexander Sasha, Dubrovsky AS, ††Department of Pediatrics,Montreal Children's Hospital,McGill University Health Centre,Montréal,QC.
- Gagnon, Isabelle, Gagnon I, ‡‡Research Institute of the McGill University Health Centre,Montréal,QC.
- Momoli, Frank, Momoli F, ‡Clinical Research Unit,Children's Hospital of Eastern Ontario Research Institute,Ottawa,ON.
- Zemek, Roger, Zemek R, §Department of Pediatrics,Children's Hospital of Eastern Ontario Research Institute,Ottawa,ON.
OBJECTIVE: Ondansetron is increasingly administered to children suffering from concussion-associated nausea/vomiting. We examined the association between ondansetron administration and post-concussion symptoms in children at 1 week and 1 month following the concussion. METHODS: This was a secondary analysis of data collected prospectively in a cohort study conducted in nine pediatric emergency departments (EDs) (5P study). Participants were children ages between 5 and 17.99 years who sustained a concussion in the previous 48 hours. For the current study, only 5P participants who reported nausea and/or vomiting in the ED were eligible. The exposure of interest was ondansetron administration; the comparison group included all other participants. The primary outcome was an increase in at least three symptoms of the Post-Concussion Symptom Inventory score at 1 week and 1 month following trauma. RESULTS: Among the 3,063 children included in the 5P study, 1805 (59%) reported nausea and provided data at 1 week and/or 1 month. Among them, 132 (7%) received ondansetron. Multivariable logistic regression adjusted for confounders did not show an association between ondansetron use and the risk of persistent post-concussion symptoms at 1 week (OR: 1.13 [95% CI: 0.86-1.49]), but it was associated with a higher risk at 1 month (OR: 1.33 [95% CI: 1.05-1.97]). CONCLUSION: In children presenting to the ED with an acute concussion, ondansetron use was associated with a higher risk of persistent post-concussion symptoms at 1 month. Although this may be related to the limitations of the design, it highlights the importance of evaluating this association using a randomized clinical trial.
