Yield and Costs of Evaluating Children with Cyclic Vomiting Syndrome

ABSTRACTBackground:Cyclic vomiting syndrome (CVS) clinical guidelines recommend an algorithm of basic testing for standard patients, and more targeted testing, including laboratory and imaging studies, in the presence of specific red flags. The cost effectiveness of this screening of children with suspected CVS is lacking.Objectives:To determine if screening studies in CVS patients results in diagnostic change, and to estimate their healthcare cost.Method:Charts of patients (1–18 years) with suspected CVS were retrospectively reviewed at a single center. Results and cost of laboratory and imaging studies were analyzed.Results:503 charts were reviewed from electronic medical records with the ICD9 code 536.2 or search terms "CVS, cyclic vomiting, persistent emesis/vomiting, hyperemesis, or intractable/ periodic vomiting". Of these, 165 (33%) had a diagnosis of CVS and 135 (82%) children (mean age 7.7 ± 4.3; 73 (54%) females) met CVS criteria based on NASPGHAN diagnostic criteria. Of those meeting CVS criteria, 6 (4%) had a change in management based on the CVS screening evaluation. The mean cost of screening per patient that met CVS criteria was $6,125.02 USD and the estimated total cost for all patients who met CVS criteria was $826,877.88 USD.Conclusion:The screening metabolic labs, pelvic ultrasound, MRI, and upper endoscopy resulted in a diagnosis change in few patients screened for CVS. Most children who met criteria for CVS did not benefit from screening evaluation as results did not change clinical diagnosis or management, and were associated with higher cost. Background: Cyclic vomiting syndrome (CVS) clinical guidelines recommend an algorithm of basic testing for standard patients, and more targeted testing, including laboratory and imaging studies, in the presence of specific red flags. The cost effectiveness of this screening of children with suspected CVS is lacking. Objectives: To determine if screening studies in CVS patients results in diagnostic change, and to estimate their healthcare cost. Method: Charts of patients (1–18 years) with suspected CVS were retrospectively reviewed at a single center. Results and cost of laboratory and imaging studies were analyzed. Results: 503 charts were reviewed from electronic medical records with the ICD9 code 536.2 or search terms "CVS, cyclic vomiting, persistent emesis/vomiting, hyperemesis, or intractable/ periodic vomiting". Of these, 165 (33%) had a diagnosis of CVS and 135 (82%) children (mean age 7.7 ± 4.3; 73 (54%) females) met CVS criteria based on NASPGHAN diagnostic criteria. Of those meeting CVS criteria, 6 (4%) had a change in management based on the CVS screening evaluation. The mean cost of screening per patient that met CVS criteria was $6,125.02 USD and the estimated total cost for all patients who met CVS criteria was $826,877.88 USD. Conclusion: The screening metabolic labs, pelvic ultrasound, MRI, and upper endoscopy resulted in a diagnosis change in few patients screened for CVS. Most children who met criteria for CVS did not benefit from screening evaluation as results did not change clinical diagnosis or management, and were associated with higher cost. Correspondence: Chantal Lucia-Casadonte, M.D, Assistant Professor of Pediatrics, The University of Kansas Medical Center, Division of Pediatric Gastroenterology, Hepatology and Nutrition, 3901 Rainbow Blvd, Mail Stop 4004, Kansas City, KS 66160 (e-mail: cluciacasadonte@kumc.edu). Received 22 December, 2016 Accepted 18 December, 2017 Conflicts of Interest and Sources of Funding: None of the authors have any conflicts of interest to disclose. This study was done without specific funding support. This article has been developed as a Journal CME Activity by NASPGHAN. Visit http://ift.tt/2ioSD8w to view instructions, documentation, and the complete necessary steps to receive CME credit for reading this article. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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