Abstract
BackgroundCyclic vomiting syndrome (CVS), a chronic disorder characterized by recurrent episodes of vomiting, is frequently unrecognized and is associated with high utilization of emergency department (ED) services.MethodsA web-based survey was posted on the Cyclic Vomiting Syndrome Association (CVSA) website to assess utilization of ED services in patients with CVS.ResultsOf 251 respondents, 104 (41.4%) were adult CVS patients and 147 (58.6%) were caregivers of pediatric and adult patients. In the adult group, the median number of ED visits for CVS symptoms was 15(range 1 - 200), with a median of 7 ED visits prior to a diagnosis of CVS (range 0 - 150). In the caregiver group, the median number of ED visits was 10 (range 1 - 175) and the median number of ED visits prior to a diagnosis of CVS was 5 (range 0 - 65). CVS was not diagnosed in the ED in 89/104 (93%) adults and 119/147 (93%) patients in the caregiver group. CVS was not recognized in the ED in 84/95 (88%) of adults and 97/122 (80%) of patients in the caregiver group, despite an established diagnosis of CVS.ConclusionThere is a sub-group of adult and pediatric CVS patients who are high utilizers of ED services and CVS is not recognized in the ED in the majority of patients. Improved efforts to educate ED physicians are indicated to optimize treatment of patients with CVS and to decrease potential overuse of ED services.
Highlights
Cyclic vomiting syndrome (CVS), a chronic disorder characterized by recurrent episodes of vomiting, is frequently unrecognized and is associated with high utilization of emergency department (ED) services
Most adult patients 55 (57%) initially presented with CVS symptoms to the ED between the ages of 18-40 years and in the caregiver group, 81 (62%) patients first presented to the ED between the ages of 2-11 years
In 80% or more of patients, CVS was not recognized in the ER both before and even after the diagnosis was established by a physician elsewhere (Table 2)
Summary
Cyclic vomiting syndrome (CVS), a chronic disorder characterized by recurrent episodes of vomiting, is frequently unrecognized and is associated with high utilization of emergency department (ED) services. Cyclic vomiting syndrome (CVS) is a chronic idiopathic functional gastrointestinal disorder that is characterized by recurrent, stereotypical, disabling, discrete episodes of intense nausea and vomiting that last a few hours to days, interspersed with varying symptom-free intervals. This disorder is primarily recognized in children, with increasing recognition in adults. Absence of nausea and vomiting between episodes and absence of metabolic, gastrointestinal, central nervous system structural or biochemical disorders. Given the problems with diagnosis of this disorder, it is likely that CVS is more common than currently thought
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