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

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


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.

MeSH terms

  • Adolescent
  • Antiemetics / therapeutic use*
  • Brain Concussion / epidemiology*
  • Canada / epidemiology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Nausea / epidemiology
  • Nausea / prevention & control*
  • Ondansetron / therapeutic use*
  • Post-Concussion Syndrome / epidemiology*
  • Vomiting / epidemiology
  • Vomiting / prevention & control*


  • Antiemetics
  • Ondansetron