Abstract
BACKGROUND: Between-country variation in health care resource use and its impact on outcomes in acute care settings have been challenging to disentangle from illness severity by using administrative data. METHODS: We conducted a preplanned analysis employing patient-level emergency department (ED) data from children enrolled in 2 previously conducted clinical trials. Participants aged 3 to,48 months with,72 hours of gastroenteritis were recruited in pediatric EDs in the United States (N = 10 sites; 588 participants) and Canada (N = 6 sites; 827 participants). The primary outcome was an unscheduled health care provider visit within 7 days; the secondary outcomes were intravenous fluid administration and hospitalization at or within 7 days of the index visit. RESULTS: In adjusted analysis, unscheduled revisits within 7 days did not differ (adjusted odds ratio [aOR]: 0.72; 95% confidence interval (CI): 0.50 to 1.02). At the index ED visit, although participants in Canada were assessed as being more dehydrated, intravenous fluids were administered more frequently in the United States (aOR: 4.6; 95% CI: 2.9 to 7.1). Intravenous fluid administration rates did not differ after enrollment (aOR: 1.4; 95% CI: 0.7 to 2.8; US cohort with Canadian as referent). Overall, intravenous rehydration was higher in the United States (aOR: 3.8; 95% CI: 2.5 to 5.7). Although hospitalization rates during the 7 days after enrollment (aOR: 1.1; 95% CI: 0.4 to 2.6) did not differ, hospitalization at the index visit was more common in the United States (3.9% vs 2.3%; aOR: 3.2; 95% CI: 1.6 to 6.8). CONCLUSIONS: Among children with gastroenteritis and similar disease severity, revisit rates were similar in our 2 study cohorts, despite lower rates of intravenous rehydration and hospitalization in Canadian-based EDs.
| Original language | English (US) |
|---|---|
| Article number | e2020030890 |
| Journal | Pediatrics |
| Volume | 147 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2021 |
Funding
FUNDING: The US-based study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant R01HD071915); the Emergency Medical Services for Children Program of the Maternal and Child Health Bureau, Health Resources and Services Administration, under cooperative agreement (awards U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC00008, U03MC22684, and U03MC22685); the Washington University Biobank Core, supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (grant P30DK052574); and iHealth, which provided Lactobacillus rhamnosus GG and placebo capsules in kind. The Canadian-based study was supported by the Canadian Institutes of Health Research (grants 286384 and 325412), the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness (to Dr Freedman), a grant from the Alberta Children’s Hospital Foundation to the Pediatric Emergency Medicine Research Associates’ Program, Calgary Laboratory Services (in kind), Provincial Laboratory for Public Health in Alberta, Luminex, and Copan Italia. Funded by the National Institutes of Health (NIH).
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health