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Bilious emesis in the pediatric emergency department: etiology and outcome
Karin Berger Sadow1, Shireen M Atabaki, Christina M S Johns
1Mount Sinai School of Medicine, Mount Sinai University Medical Center, New York, USA.
Insights
Pediatric bilious emesis, a sign of potential gastrointestinal issues, rarely indicates surgical disease. This study found no significant link between emesis color and the need for surgery in children.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Surgical Pediatrics
Background:
- Bilious emesis in children is a concerning symptom that may indicate serious underlying pathology.
- Previous studies have highlighted the importance of evaluating pediatric patients with bilious emesis for surgical emergencies.
Purpose of the Study:
- To characterize emergency department (ED) diagnoses in a broad pediatric population presenting with bilious emesis.
- To determine the incidence of surgical disease in children with yellow or green emesis.
Main Methods:
- A multicenter, prospective, observational case series.
- Convenience sampling of patients under 21 years old with yellow or green emesis.
- Clinical review conducted at least 2 weeks post-ED disposition.
Main Results:
- 227 patients (230 ED encounters) were enrolled; 189 had follow-up.
- Surgical disease was identified in 10.6% of encounters with follow-up (20 cases).
- No significant association was found between emesis color and surgical disease (OR = 2.3).
Conclusions:
- The majority of pediatric emergency department visits for bilious emesis do not result in a surgical diagnosis.
- Emesis color (yellow or green) is not a reliable predictor of surgical disease in this pediatric population.
Abstract:
The objective of this study was to describe the emergency department (ED) diagnoses in an unselected pediatric population with bilious emesis. In a multicenter, prospective, observational case series, a convenience sample of patients less than 21 years old with yellow or green emesis were assembled. Clinical review of each case was performed 2 weeks or longer after ED disposition. Two hundred twenty-seven patients with 230 ED encounters were enrolled. Of the 189 encounters (82.2%) with follow-up, 20 had surgical disease (10.6%; 95% C.I. 6.6%, 15.9%). There was no significant association between the color of the emesis and surgical disease (OR = 2.3; 95% CI, 0.68, 8.6).