Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits.
BACKGROUND
Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP.


METHODS
We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of "nausea and vomiting in pregnancy" or "hyperemesis gravidarum." Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses.


RESULTS
There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06-1.61]), high parity (OR 1.50 95% CI [1.12-2.00]), and early gestational age (OR 0.74 95% CI [0.60-0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59-0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002).


CONCLUSIONS
NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition.
University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin.
Brian R
BR
Sharp
University of Wisconsin School of Medicine and Public Health, Department of Obstetrics and Gynecology, Madison, Wisconsin.
Kristen M
KM
Sharp
University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin.
Brian
B
Patterson
University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan.
Suzanne
S
Dooley-Hash
D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006112:Gravitation; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D009325:Nausea / Q000188:drug therapy* / Q000209:etiology; D010298:Parity; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies