425 - Trends in Diagnosis and Management of Cannabinoid Hyperemesis Syndrome Presenting to Pediatric ED's: PHIS Database Study

Publication Number: 4416.425

Sudershan Subedi, Akron Children's Hospital, Hudson, OH, United States; Jonathan Pelletier, Akron Children's Hospital, Akron, OH, United States; Martha Blackford, Akron Children's Hospital, Akron, OH, United States; Seth W. Linakis, Akron Children's Hospital, Akron, OH, United States; Sarah Kline-Krammes, Akron Children's Hospital, Akron, OH, United States; Michelle Bestic, Akron Children's Hospital, Akron, OH, United States

Background: Cannabis use has been steadily increasing with expanding legalization and increased access to cannabinoid products. Cannabinoid Hyperemesis Syndrome (CHS) is characterized by recurrent nausea, vomiting, and abdominal pain and frequently relieved by hot bathing. First identified in 2004, CHS is often challenging to diagnose. While adult research shows frequent ED visits and recurrence, pediatric data are limited.

Objective: 1. To evaluate the trend in the diagnosis and management of CHS among adolescent patients (ages 12-21 years) presenting to pediatric emergency departments (EDs) from January 1, 2016 - December 31, 2024.
2. To assess the pattern of healthcare resource utilization including length of stay (LOS), diagnostic modalities, and cost

Design/Methods: We conducted a retrospective study using the Pediatric Health Information System (PHIS) database to identify cases of CHS among patients aged 12-21 presenting to pediatric EDs between Jan 2016-Dec 2024. CHS cases were defined by a combination of ICD-10 codes for nausea/vomiting (R11) and cannabinoid-related disorders (F12 and T40.7x), while excluding patients with confounding diagnoses, chronic complex conditions, or surgical procedures. Summary statistics of demographics and resource utilization were provided. Changes in visit count per year were analyzed with linear regression.

Results: A total of 11,251 encounters were identified among 8,912 patients across 40 hospitals over the 9-year time frame. The annual number of ED encounters increased by an average of 270 cases per year (p < 0.001, 95% CI: 222-318), Figure 1. Among the encounters, 25.7% were admitted, 17.3% were placed under observation, and 57.0% were discharged from ED. The median LOS was 1 day (IQR: 1-2) and median standardized cost was $2,141 (IQR $1,081-$7,126), Table 1. Laboratory testing was frequently ordered: BMPs (68.1%), CBCs (60.4%), and urine toxicology (59.2%). Abdominal X-rays were ordered for 16.4% of patients. Anxiety was identified as the most common co-existing mental health issue (15.8%). Medications frequently ordered included ondansetron (66.7%), diphenhydramine (19.5%), lorazepam (16.7%), haloperidol (16.1%), and capsaicin cream (12.7%), Table 2.

Conclusion(s): This study highlights a significant rise in peds ED visit for CHS over a nine-year period. The findings reveal substantial healthcare resource utilization, including frequent laboratory and imaging tests, medication administration, and hospital admissions. Future work is needed to increase awareness and standardize diagnosis and management.

Figure 1. ED Encounters with a Cannabinoid Hyperemesis diagnosis from 2016-2024 reported to the Pediatric Health Information System.


Table 1: Disposition, length of stay and total cost for patients with ED encounters for Cannabinoid Hyperemesis over a 9-year period.


Table 2: Resource utilization for patients presenting to ED with Cannabinoid Hyperemesis over a 9-year period.