Analysis of two treatment modalities for the prevention of vomiting after trauma: Orogastric tube or anti-emetics.

Abstract

Vomiting in the emergency department after trauma occurs frequently and might lead to aspiration of gastric content. An orogastric tube (OGT) is a way to prevent emesis. However, this is an inconvenient procedure and may actually trigger vomiting. Therefore, a change in policy was applied from preferably an OGT to the administration of anti-emetics in a selected population. The aim of this study was to analyse the prevention of vomiting in trauma patients after OGT or anti-emetics. Retrospective cohort study. Data of all trauma patients presented at the crash room of the emergency department between July 1st 2013 and July 1st 2014 were collected from the local trauma registry and electronic patient documentation system and comprising 6 months preceding and 6 months after change of policy. Vomiting and nausea after trauma were recorded. Furthermore, complications such as aspiration and cardiac arrhythmias were documented. A total of 1446 patients were presented after trauma. 230 patients were promptly intubated. An additional 763 patients were fully responsive and did not complain of nausea. The remaining 453 patients were further analysed. 44 patients received OGT placement procedure and 409 patients received anti-emetics. Significant difference was found in patients vomiting after OGT placement or anti-emetics (20.5% vs. 2.7%; P<0.001). Patients who received anti-emetics were not more at risk for cardiac arrhythmias. After matched control analysis, there was still a significant difference was found. Administration of anti-emetics is suitable and effective for the prevention of vomiting after trauma in this selected population, without an increased risk for complications.