Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in thefirst trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidenceexists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were toevaluate 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 asingle, large academic hospital. Demographic and treatment variables were collected using a chart reviewof 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesisgravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for thesame 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 onlyearly gestational age (OR 0.74 95% CI [0.59-0.91]) was associated with increased return ED visits in amultiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits(p=0.002).

Conclusion: 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 EDvisits are present, may improve quality of care and reduce ED utilization for this condition. [West J EmergMed. 2016;17(5)585-590.]