Abstract
Aim: To analyze the clinical characteristics, trends in hospitalization and health care resource utilization of pediatric patients with cyclical vomiting syndrome (CVS). Methods: We analyzed the latest 5 Healthcare Cost and Utilization Project-Kids Inpatient Database (HCUP-KID) datasets including years 2003, 2006, 2009, 2012 and 2016 for patients aged 1–20 years with a primary diagnosis of CVS and were compared with Age/gender-matched controls for comorbidities, clinical outcomes, and healthcare resource utilization. Results: A total of 12,396 CVS-related hospitalizations were analyzed. The mean age of CVS patients was 10.4 ± 6.7 years. CVS was associated with dysautonomia (OR: 12.1; CI: 7.0 to 20.8), dyspepsia (OR: 11.9; CI: 8.8 to 16.03), gastroesophageal reflux disease (OR: 6.9; Confidence Interval (CI): 6.4 to 7.5), migraine headaches (OR: 6.8; CI: 5.9 to 7.7) and irritable bowel syndrome (OR: 2.08; CI: 1.2 to 4.3) (all p < 0.001). CVS was also associated with increased cannabis use (OR: 5.26, 4.6 to 5.9; p < 0.001), anxiety disorder (OR: 3.9; CI: 3.5 to 4.4) and stress reaction (OR: 3.6; CI: 2.06 to 6.3), p < 0.001. Mean CVS-related hospitalization costs (inflation adjusted) more than doubled from $3199 in 2003 to $6721 in 2016, incurring $84 million/year in total costs. Conclusion: Hospitalized CVS patients have increased prevalence of DGBIs, dysautonomia, psychiatric conditions and cannabis use compared to non-CVS controls. CVS-related hospitalizations in U.S. is associated with increasing health care costs. Better management of CVS and comorbid conditions is warranted to reduce health care costs and improve outcomes.
Highlights
The cyclical vomiting syndrome (CVS) group had a higher proportion comorbidity including irritable bowel syndrome (1% vs. 0.1%), dysautonomia (0.6% vs.
The proportion of CVS patients with migraine headache was significantly higher compared to the non-CVS population (5.6% vs. 0.8%) (p < 0.001)
Our study revealed that the rate of pediatric CVS-related hospitalizations has remained overall stable over time except in 2016 in which the rate of hospitalization had decreased, this could be related to the transition from International Classification of Diseases (ICD)-9 to ICD-10 codes
Summary
Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction (DGBI), characterized by recurrent, stereotypical episodes of nausea and vomiting lasting from hours to days [1]. The prevalence rate of pediatric CVS is reported between 1.1 and 6.1% from population-and school-based surveys and data from tertiary care centers [2,3,4,5,6]. A recent population-based study demonstrated a CVS prevalence of 2% among U.S adults [7]. Comparable data is not available in children one population-based survey from
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