Abstract
Background
There have been recent reports of increased QT interval after head trauma in concussed
athletes and adult patients. Ondansetron, which is widely used in treatment of nausea
and vomiting symptoms in head injuries, was issued a safety warning from the U.S.
Food and Drug Administration regarding QT prolongation and risk of fatal arrhythmias.
Objective
The purpose of this study was to evaluate the safety of ondansetron regarding QT prolongation
for patients experiencing nausea or vomiting after head trauma.
Methods
Patients aged 1–20 years presenting to a pediatric emergency department with head
trauma and who required a dose of ondansetron for nausea or vomiting were enrolled
in the study. Patients received a baseline 12-lead electrocardiogram (ECG) prior to
administration of either oral or IV ondansetron. A second post-ondansetron 12-lead
ECG was performed after administration of ondansetron. All ECGs were reviewed and
the QTc calculated manually by a board-certified pediatric cardiologist.
Results
Forty-two patients met enrollment criteria. Five patients received IV ondansetron
and 37 received oral ondansetron. Mean QTc pre ondansetron was 387.5 ms and mean QTc
post ondansetron was 400.9 ms (p = 0.120). We found no statistically significant difference in other ECG parameters
pre and post ondansetron.
Conclusions
Ondansetron is safe in regard to QTc prolongation in patients with head trauma. Based
on this research, ondansetron should continue to be used for the treatment of nausea
and vomiting in emergency department patients who present with head injury.
Keywords
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Article info
Publication history
Published online: March 12, 2023
Accepted:
March 7,
2023
Received in revised form:
January 30,
2023
Received:
December 11,
2022
Publication stage
In Press Uncorrected ProofFootnotes
Remon Assaad, MD, is currently at the Department of Emergency Medicine, Rochester General Hospital, Rochester, NY.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
