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.
Sexually transmitted infections (STIs) continue to be a great concern in the adolescent population and of particular concern to the pediatric emergency medicine physician. The Centers for Disease Control and Prevention reports that rates of gonorrheal and chlamydial infections are greatest in female adolescents, aged 15 to 19 years, and many people acquire human papilloma virus and human immunodeficiency virus infections during their teenage years. Adolescents continue to be at a higher risk for acquiring STIs because of multiple factors, including being more biologically susceptible, more likely to engage in unprotected sex with multiple partners, as well as facing various obstacles to their use of the health care system. The pediatric emergency medicine physician must be aware of the various presentations of STIs in their patients, as well as how to adequately treat and offer counseling to this vulnerable population.
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