Treatment and assessment of emergency department nausea and vomiting in Australasia: a survey of anti-emetic management

Abstract

Objective: To describe the treatment and assessment of emergency department nausea and vomiting (EDNV) in Australasia by Fellows of the Australasian College for Emergency Medicine (FACEM). To determine the influence of various factors on FACEM anti-emetic choice. To compare the influence of drug effectiveness, side effects, cost and pharmacy directives on adult EDNV anti-emetic choice between FACEM choosing the two most common first-line agents.

Methods: A cross-sectional survey of all FACEM practising in Australasian ED was conducted by mail-out in February 2009.

Results: Of all FACEM surveyed 48.7% (532/1092) responded. The most common first-line drugs for adult EDNV were metoclopramide (87.3%, 453/519), 5HT3 antagonists (7.9%, 41/519) and prochlorperazine (2.3%, 12/519). For paediatric EDNV, the most common first-line agents were 5HT3 antagonists (86.2%, 307/356), metoclopramide (6.7%, 24/356) and promethazine (5.1%, 18/356). For most FACEM anti-emetic choice was highly influenced by perceived drug efficacy (96.1%) and side effects (82.5%), and 32.9% of FACEM were highly influenced by drug cost. Few FACEM reported ED anti-emetic protocols for adults (13.0%) or children (16.7%) in their ED. FACEM seldom used scales or tools to measure EDNV severity in adult (2.5%) or paediatric (3.4%) patients.

Conclusions: Fellows of the Australasian College for Emergency Medicine anti-emetic choice in Australasian ED has been described. The main influences on anti-emetic choice were patient age, perceived drug efficacy and drug side-effect profiles.