Why does this matter?
Isolated vomiting may be “just a virus,” but it also may be a sign of other things – rarely, intracranial pathology – or more commonly, UTI. How often do children with isolated vomiting have a routine viral illness?
This was a prospective study of 2,695 children in 2 Canadian EDs with acute gastroenteritis symptoms of vomiting and/or diarrhea and all had molecular testing on stool – or rectal swab if no diarrhea.
Enteropathogen identification was most common in those with both vomiting and diarrhea (81% of the time), but children with either isolated vomiting or diarrhea each had an enteropathogen recovered over half of the time. Norovirus was the most common culprit if isolated vomiting. Kids with isolated vomiting more often had additional workup, like UA or imaging. With C. difficile excluded, 6% of children with isolated vomiting had a bacterial pathogen identified.
Management was up to the treating physician, so there was variability in the workup, but this was meant to be a real-world study.
If you see a child with isolated vomiting and say, “It’s just a virus,” you’ll be correct more than half the time. However, alternative diagnoses were found in these children 5.7% of the time, with UTI the most common.
Microbial Etiologies and Clinical Characteristics of Children Seeking Emergency Department Care Due to Vomiting in the Absence of Diarrhea. Clin Infect Dis. 2021 Oct 20;73(8):1414-1423. doi: 10.1093/cid/ciab451.