Early Intervention May Prevent Hospitalization Among Children With Cyclic Vomiting Syndrome

Children with cyclic vomiting syndrome (CVS) who are younger, who are boys, and who have a delayed presentation to the emergency department (ED) are more likely to be hospitalized for CVS, according to findings from a study presented at the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) Annual Meeting and Postgraduate Course. The findings suggest early intervention can mitigate the need for hospitalization.

Factors associated with an increased likelihood of hospitalization for CVS among children are poorly understood.

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To understand this, researchers from Nationwide Children’s Hospital in Columbus, Ohio, retrospectively reviewed the charts of patients with CVS who had been seen at the institution between 2015 and 2018. A total of 142 patients met Rome IV diagnostic criteria for CVS and were included in the analysis.

Among the patients, 53% were girls. The median age of the patients was 11 years (range, 4-17 years).

Results showed that 35 patients (24.6%) had presented to the ED 149 times during the time period. Of those visits, 93 led to hospitalization (62.4%).

Patients younger than 12 years were more likely to be hospitalized compared with patients older than 12 years (74% vs 40%). Boys were more likely to be hospitalized than girls (78.0% vs 51.7%). Additionally, patients who presented to the ED more than 24 hours after onset of symptoms were more likely to be hospitalized compared with patients who presented less than 24 hours after onset of symptoms (80.3% vs 48.8%).

After controlling for age, gender, and time to presentation, the mean wait time until initial intravenous (IV) antiemetic dose was administered was 2.8 hours among children who were hospitalized compared with 2.1 hours among children who were discharged.

The wait time until initial IV fluid bolus was administered was similar between the patients who were hospitalized and the patients who were discharged (2.6 hours vs 2.3 hours).

“These findings suggest that early intervention, both patient-driven (pre-ED) and provider-driven thereafter, is key to successfully managing severe CVS episodes and mitigating the need for hospitalization,” the authors concluded.

—Melinda Stevens

Reference:

Abdulkader Z, Bali N, Vaz K, Yacob D, Di Lorenzo C, Lu P. Predictors of hospitalization for children with cyclic vomiting syndrome [abstract 41]. Presented at: NASPGHAN Annual Meeting and Postgraduate Course; October 17-19, 2019; Chicago, IL.

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