ArticlePediatric emergency care2026
Implementation of a Standardized Management Algorithm for Cannabis Hyperemesis Syndrome in a Pediatric Emergency Department.
Article in Pediatric emergency care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
objectivesCannabis hyperemesis syndrome (CHS) is an increasingly common cause of pediatric emergency department (ED) visits, yet management pathways remain understudied. We evaluated clinical outcomes following the implementation of a CHS management algorithm in a pediatric ED.
methodsWe conducted a retrospective study of encounters by adolescents before and after implementation of a CHS management algorithm in an academic pediatric ED from July 2020 to July 2024. We examined medications administered, length of stay, disposition, and return visits before and after implementation using chi-square, Fisher exact, or Mann-Whitney U tests as appropriate. We used mixed-effects models to examine the association of time period and admission rates, adjusting for age, sex, and emergency severity index level. A similar model examined the association of time period and ED length of stay that was also adjusted for total daily ED arrivals.
resultsOf 533 screened encounters, 128 met inclusion criteria, representing 44 unique patients. Following algorithm implementation, administration rates increased for capsaicin (2.7% vs. 22.2%, P <0.001) and metoclopramide (6.8% vs. 42.6%, P <0.001). Frequency of haloperidol administration did not change significantly (20.3% vs. 9.3%, P =0.138), but mean dose decreased (2.7 mg vs. 1.0 mg, P =0.014). The adjusted odds of hospital admission (adjusted OR: 0.57, 95% CI: 0.17, 1.86) and ED length of stay (adjusted beta: -0.01, 95% CI: -0.21, 0.20) did not significantly differ.
conclusionsAlgorithm implementation was associated with increased capsaicin and metoclopramide use but no change in admission rates or length of stay. Prospective studies are needed to assess optimal CHS management in children.
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