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CJEM. 2019 Mar;21(2):204-210. doi: 10.1017/cem.2018.384. Epub 2018 Jun 7.

Association between ondansetron use and symptom persistence in children with concussions: A 5P substudy.

Author information

1
*Department of Pediatrics,CHU Sainte-Justine,Université de Montréal,Montréal,QC.
2
†Department of Pediatrics,The Hospital for Sick Children,University of Toronto,Toronto,ON.
3
‡Clinical Research Unit,Children's Hospital of Eastern Ontario Research Institute,Ottawa,ON.
4
¶Department of Psychology,Université de Montréal,Montréal,QC.
5
**Department of Pediatrics,Alberta's Children Hospital,Calgary,AB.
6
††Department of Pediatrics,Montreal Children's Hospital,McGill University Health Centre,Montréal,QC.
7
‡‡Research Institute of the McGill University Health Centre,Montréal,QC.
8
§Department of Pediatrics,Children's Hospital of Eastern Ontario Research Institute,Ottawa,ON.

Abstract

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.

KEYWORDS:

children; concussion; ondansetron

PMID:
29877168
DOI:
10.1017/cem.2018.384

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