Minor head injury is a common presentation to Paediatric Emergency Departments (PED). Various clinical decision rules exist to help clinicians decide which patients require radiological investigation, several include 3 or more discreet vomits. Anecdotally there is a subgroup of patients with minor head injury (MHI) who have intercurrent illnesses (ICI), however there is a paucity of research into this group and their management, particularly with regards imaging. Objectives 1) To quantify the

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... oportion of children (aged 0-4 yrs) who present to the PED with MHI and have symptoms of ICI. 2) To determine if these children are more likely to vomit than their counterparts. 3) To establish current clinical practice for children with ICI and vomiting post MHI. Results Of 1203 children aged 0-4 yrs presenting to a PED in central London between April 2011 and 2012 with minor head injury, 88 (7.3%) had symptoms of an ICI. Children who had symptoms of ICI (38/88) were more likely to vomit than those who did not (92/1112) (p < 0.001). Of 16 patients who had an ICI and 3 or more vomits following head injury only 2/16 (12.5%) underwent CT head compared with 8/27 (29.6%) in the non ICI group. There were no cases of brain injury in either group. Conclusion Minor head injury occurs frequently in the presence of ICI in younger children. These patients are more likely to vomit and clinicians are consciously contradicting current guidelines and interpreting imaging criteria within a clinical context.