Patient-reported outcomes in cannabinoid hyperemesis syndrome patients treated in the emergency department: a pilot study.

Abstract

Objective: Abdominal pain is one of the most common emergency department (ED) complaints, with many patients experiencing recurrent episodes due to cannabinoid hyperemesis syndrome (CHS), a syndrome characterized by pain and vomiting in the setting of chronic cannabis use. This pilot study aimed to demonstrate the ability to enroll patients with CHS, characterize patient-reported outcomes (PROs), and estimate 30-day revisit rates.

Methods: This prospective observational study enrolled adult ED patients with CHS at an academic center and community affiliate. The inclusion required a prior diagnosis of CHS and ED clinician judgment that symptoms at time of enrollment were likely due to CHS. Exclusions included unstable clinical status or other high-risk conditions. Primary outcomes included characterization of symptoms, assessment of multiple domains of PROs, measurement of the use of both computed tomography (CT) scans and opioid analgesia, and frequency of 30-day ED return visits.

Results: A total of 18 participants were enrolled (mean age, 34 years; 10 female patients, 55.6%). Automated chart reviews were completed for each outcome of interest at 30 days and at 12 months. Pain severity was high (mean triage pain score, 6.2±4.3) and prior CT imaging was noted in 13 patients (72.2%) in the past 5 years. Opioids were administered in four patients (22.2%), while the 29-Item Patient-Reported Outcome Measurement Information System (PROMIS-29) scores highlighted high risk of anxiety (mean T-score, 56.11±11.45) and how pain interfered with normal activities of living (mean T-score, 62.24±11.11). Return visits occurred in three patients (16.7%) within 30 days.

Conclusion: ED patients with CHS show a significant burden on PROs and high 30-day revisit rates. Future studies should consider interventions that address PROs and reduce ED revisits.