Review the Contributing Factors Associated With Emesis and Enteral Nutrition Intolerance in Patients With Disorders of Consciousness

Research Objectives Review the presence of the risk factors for emesis in patients with DOC. Design Retrospective review of factors of emesis via chart review. Data collection included patient onset of injury, age, gender, brain injury diagnosis, CRS-R diagnostic category, opioids, enteral nutrition (EN) administration, pharmacological agents and the diagnosis of diabetes or hydrocephalus. Setting Inpatient rehabilitation hospital. Participants All patients admitted to the disorders of consciousness (DOC) program between 2017 and 2019 that received scheduled metoclopramide or ondansetron. Patients with DOC exhibit altered gastric emptying which contribute to the presence of emesis and enteral nutrition (EN) intolerance. Previously identified risk factors include diabetes, hydrocephalus, vestibular dysfunction, hyperglycemia, opioid use, pharmacological agents and bolus vs continuous nutrition administration. Interventions None. Main Outcome Measures Incidence of different risk factors. Results 28 patient admissions were included, 54% with traumatic brain injury (TBI) and 46% with non-TBI. Increased risk of emesis was associated with the diagnosis of hydrocephalus (54%) and opioid use (25%). Pharmacological agents with highest incidence were levetiracetam (57%) and intrathecal baclofen (ITB) (50%). 70% patients received continuous EN. Conclusions The presence of emesis may place the patient at increased risk for infections, malnutrition and prolonged hospital stay. Understanding the etiology of emesis will aid in the approach to treatment, though our findings indicate this is a multifactorial issue. The presence of hydrocephalus, opioids, ITB and levetiracetam were the most common contributing factors, though no modifiable factors were identified. Future research will focus on effectiveness of treatment with the goal of improving patient outcomes. Author(s) Disclosures The authors have nothing to disclose. Review the presence of the risk factors for emesis in patients with DOC. Retrospective review of factors of emesis via chart review. Data collection included patient onset of injury, age, gender, brain injury diagnosis, CRS-R diagnostic category, opioids, enteral nutrition (EN) administration, pharmacological agents and the diagnosis of diabetes or hydrocephalus. Inpatient rehabilitation hospital. All patients admitted to the disorders of consciousness (DOC) program between 2017 and 2019 that received scheduled metoclopramide or ondansetron. Patients with DOC exhibit altered gastric emptying which contribute to the presence of emesis and enteral nutrition (EN) intolerance. Previously identified risk factors include diabetes, hydrocephalus, vestibular dysfunction, hyperglycemia, opioid use, pharmacological agents and bolus vs continuous nutrition administration. None. Incidence of different risk factors. 28 patient admissions were included, 54% with traumatic brain injury (TBI) and 46% with non-TBI. Increased risk of emesis was associated with the diagnosis of hydrocephalus (54%) and opioid use (25%). Pharmacological agents with highest incidence were levetiracetam (57%) and intrathecal baclofen (ITB) (50%). 70% patients received continuous EN. The presence of emesis may place the patient at increased risk for infections, malnutrition and prolonged hospital stay. Understanding the etiology of emesis will aid in the approach to treatment, though our findings indicate this is a multifactorial issue. The presence of hydrocephalus, opioids, ITB and levetiracetam were the most common contributing factors, though no modifiable factors were identified. Future research will focus on effectiveness of treatment with the goal of improving patient outcomes.