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Acute Management of Pediatric Cyclic Vomiting Syndrome: A Systematic Review
Shannon Gui1, Nimita Patel2, Robert Issenman3
1Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Insights
Ondansetron is effective for pediatric cyclic vomiting syndrome rescue therapy. Further research is needed for abortive therapies like sumatriptan and aprepitant to improve pediatric emergency care.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Pharmacology
Background:
- Cyclic vomiting syndrome (CVS) is a debilitating condition in children.
- Effective pharmacologic management in acute care settings is crucial.
Purpose of the Study:
- To synthesize quantitative and qualitative data on pharmacologic interventions for pediatric CVS.
- To evaluate their effectiveness in acute care settings.
Main Methods:
- Systematic review of 799 studies (1954-2018) from multiple databases.
- Inclusion/exclusion criteria applied by two independent reviewers.
- Separation of studies into quantitative (case series) and qualitative (expert recommendations) groups.
Main Results:
- Ondansetron demonstrated the most evidence for rescue therapy in pediatric emergency departments.
- Sumatriptan and aprepitant show potential as abortive therapies.
- Qualitative data from case reports have limited applicability.
Conclusions:
- Ondansetron is recommended for pediatric CVS rescue therapy.
- Sumatriptan and aprepitant warrant further investigation as abortive treatments.
- Need for prospective, controlled studies to optimize pediatric CVS management.
Objectives:
To synthesize quantitative and qualitative data on pharmacologic interventions of pediatric cyclic vomiting syndrome and their effectiveness in disease management in the acute care setting.
Study Design:
Using keywords, 799 studies published up from December 1954 to February 2018 were extracted from MEDLINE via Pubmed, Embase via OVID, CINAHL via EBSCO, and Cochrane Controlled Trials Registry. Studies were evaluated for inclusion and exclusion by 2 independent reviewers using predetermined inclusion and exclusion criteria.
Results:
The search yielded 84 studies for full review, of which 54 were included in the systematic review. Studies were subsequently separated into 1 group of 6 case series studies containing quantitative data on sumatriptan, ondansetron, phenothiazines, prokinetic agents, carbohydrate, isometheptene, and aprepitant; 1 one group consisting only of qualitative studies containing expert recommendations.
Conclusions:
Ondansetron has the most quantitative and qualitative evidence to support its inclusion in pediatric emergency department protocols as a rescue therapy. Sumatriptan and aprepitant are potential candidates for inclusion as abortive therapies. Qualitative data from retrospective studies and case reports are not applicable to a larger patient population. This report informs a need for controlled, prospective cohort studies and randomized, controlled trials to optimize current management protocols and to develop new medical interventions.
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