The study evaluates the utility of aprepitant in managing pediatric Cyclic Vomiting Syndrome (CVS) using data from the Pediatric Health Information System (PHIS). Despite longer hospital stays and higher costs in the aprepitant group, no significant reduction in 7-day readmission rates was observed. Clarification is needed on why clinical severity indices (e.g., vomiting frequency) were not included in propensity score matching, as these could provide a more accurate assessment of aprepitant’s effectiveness. A visual representation of readmission trends and more detail on how differences from prior studies (e.g., adult populations) were contextualized would enhance understanding. Could the authors elaborate on these points?
The comment raises valid points regarding the inclusion of clinical severity indices in propensity score matching, as such variables might refine the analysis. However, my understanding is that the study utilized the Pediatric Health Information System (PHIS) database, which primarily relies on administrative coding. If this is correct, variables such as vomiting frequency or symptom duration might not have been available in this dataset. Regarding the visual representation of readmission trends, I believe the authors aimed to focus on statistical analyses rather than graphical summaries, as this aligns with the database’s strengths in large-scale comparisons rather than detailed individual trends. Finally, the study’s discussion of differences with prior adult-focused research, while not exhaustive, does highlight key contrasts. Could the authors clarify if the limitations of the PHIS database influenced the decision not to include certain clinical variables or visual data presentations? Please correct me if I have misunderstood any aspect of the methodology or data limitations.