151 - A Retrospective Chart Review of Inpatient Cannabis Hyperemesis Syndrome Admissions at an Academic Children's Hospital

Publication Number: 1141.151

Adam Kronish, Mass General Brigham for Children, Watertown, MA, United States; Sanjay Chainani, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Lia Jo Destefano, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Andrea J. Bonilla Ospina, Drexel University College of Medicine, Philadelphia, PA, United States; Vanaja Danda, Childrens Hospital of Philadelphia, Hutto, TX, United States; Jonathan R. Pletcher, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Scott K. Jelinek, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: With rising cannabis use among adolescents and young adults (AYA) and the rise of cannabis-associated ED visits nationally, understanding how to best care for AYAs experiencing complications due to cannabis use, specifically Cannabis Hyperemesis Syndrome (CHS), is critical. However, pediatric CHS presentation patterns and inpatient management remain minimally characterized.

Objective: To describe the demographic and admission characteristics of inpatient CHS encounters, examine trends in admission frequency and length of stay, and assess the prevalence of comorbid malnutrition among hospitalized CHS patients.

Design/Methods: A retrospective chart review was conducted of youth aged 12-24 years who were admitted to an academic children's hospital within the last five years (2019-2024). Inpatient encounters were included if they met one or more of the following criteria: (1) CHS diagnosis (ICD-10 R11.16), (2) administration of capsaicin during admission, or (3) co-occurrence of a cannabis-related diagnosis (ICD-10 F12.*) and a symptom-related diagnostic code (vomiting, cyclic vomiting, dehydration, or abdominal pain). Demographic and clinical  data were extracted from the electronic medical record. Descriptive analyses were performed to characterize patients and encounters, and the study was deemed exempt by the institutional review board.

Results: A total of 220 unique patients met inclusion criteria, comprising  377 inpatient encounters over the five-year period. Of these encounters, 48 (12.7%) were identified by the CHS diagnosis code, 119 (31.6%) by capsaicin use, and 144 (38.2%) by the combination of cannabis- and symptom-related diagnostic codes;  66 encounters (17.5%) met more than one inclusion criterion. Demographic characteristics included a mean age of 17.3 years (SD 2.1), female predominance (63.2%, n = 139), and nearly even insurance coverage between public (48.2%) and private insurance (50.0%). The median length of stay was 5.1 days (mean 11.7 days, SD 22.8), and admissions occurred most frequently in the summer (31.8%) and fall (28.4%). Most patients (58.4%) had a single inpatient admission, while 14.6% had two and 8.2% had three. A comorbid diagnosis of malnutrition was documented in 42.7% (n = 161) of encounters.

Conclusion(s): Inpatient CHS encounters showed heterogeneity in diagnostic coding with fewer than 15% coded specifically for CHS, suggesting that CHS may be under-recognition or under-coded. The frequency of comorbid malnutrition highlights the nutritional impact of CHS symptoms and potential coexisting conditions.

Table 1: Patient Characteristics
Demographic and Patient-Level Information for patients with CHS inpatient encounters

Figure 1: Total Annual Encounters and Mean Admissions per Patient
The bar graph demonstrates the total number of inpatient encounters per calendar year. The line graph shows the mean number of admissions per patient per calendar year

Figure 2: CHS Encounters by Inclusion Criteria
The Venn Diagram demonstrates how patient encounters were identified by inclusion criteria (1) CHS diagnosis (ICD-10 R11.16), (2) administration of capsaicin during admission, or (3) co-occurrence of a cannabis-related diagnosis (ICD-10 F12.*) and a symptom-related diagnostic code (vomiting, cyclic vomiting, dehydration, or abdominal pain)