Abstract
IMPORTANCE Despite guidelines endorsing oral rehydration therapy, intravenous fluids are commonly administered to children with acute gastroenteritis in high-income countries. OBJECTIVE To identify factors associated with intravenous fluid administration and hospitalization in children with acute gastroenteritis. DESIGN, SETTING, AND PARTICIPANTS This study is a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) probiotic trials. Participants include children aged 3 to 48 months with 3 or more watery stools in 24 hours between November 5, 2013, and April 7, 2017, for the PERC study and July 8, 2014, and June 23, 2017, for the PECARN Study. Children were from 16 pediatric emergency departments throughout Canada (6) and the US (10). Data were analyzed from November 2, 2018, to March 16, 2021. EXPOSURES Sex, age, preceding health care visit, distance between home and hospital, country (US vs Canada), frequency and duration of vomiting and diarrhea, presence of fever, Clinical Dehydration Scale score, oral ondansetron followed by oral rehydration therapy, and infectious agent. MAIN OUTCOMES AND MEASURES Intravenous fluid administration and hospitalization. RESULTS This secondary analysis of 2 randomized clinical trials included 1846 children (mean [SD] age, 19.1 [11.4] months; 1007 boys [54.6%]), of whom 534 of 1846 (28.9%) received oral ondansetron, 240 of 1846 (13.0%) received intravenous rehydration, and 67 of 1846 (3.6%) were hospitalized. The following were independently associated with intravenous rehydration: higher Clinical Dehydration Scale score (mild to moderate vs none, odds ratio [OR], 8.73; 95%CI, 5.81-13.13; and severe vs none, OR, 34.15; 95%CI, 13.45-86.73); country (US vs Canada, OR, 6.76; 95%CI, 3.15- 14.49); prior health care visit with intravenous fluids (OR, 4.55; 95%CI, 1.32-15.72); and frequency of vomiting (per 5 episodes, OR, 1.66; 95%CI, 1.39-1.99). The followingwere independently associated with hospitalization: higher Clinical Dehydration Scale score (mild to moderate vs none, OR, 11.10; 95%CI, 5.05-24.38; and severe vs none, OR, 23.55; 95%CI, 7.09-78.25) and country (US vs Canada, OR, 3.37; 95%CI, 1.36-8.40). Oral ondansetron was associated with reduced odds of intravenous rehydration (OR, 0.21; 95%CI, 0.13-0.32) and hospitalization (OR, 0.44; 95%CI, 0.21-0.89). CONCLUSIONS AND RELEVANCE Intravenous rehydration and hospitalization were associated with clinical evidence of dehydration and lack of an oral ondansetron-supported oral rehydration period. Strategies focusing on oral ondansetron administration followed by oral rehydration therapy in children with dehydration may reduce the reliance on intravenous rehydration and hospitalization.
| Original language | English (US) |
|---|---|
| Pages (from-to) | E216433 |
| Journal | JAMA network open |
| Volume | 4 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 19 2021 |
Funding
This document was prepared by the PECARN EMSC Data Coordinating Center (DCC) located at the University of Utah School of Medicine, Salt Lake City, Utah. The document was written and typeset using LATEX 2". The DCC at the University of Utah is supported by Cooperative Agreement U03-MC00008 from the Emergency Medical Services for Children (EMSC) Program, Maternal and Child Health Bureau, Health Resources and Services Administration. Funding/Support: This work was supported in part by grants 286384 and 325412 from the Canadian Institutes of Health Research (Dr Freedman), the Alberta Children’s Hospital Foundation’s Professorship in Child Health and Wellness (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–Alberta Public Laboratories, Luminex Corporation, and Copan Italia. This study was supported in part by grant R01HD071915 from the NICHD (Dr Schnadower) and the Richard and Barbara Ruddy Endowed Chair in Emergency Medicine at Cincinnati Children's Hospital Medical Center (Dr Schnadower). The Pediatric Emergency Care Applied Research Network (PECARN) was supported by the HRSA of the US Department of Health and Human Services (HHS) and the Emergency Medical Services for Children program through the following grants: DCC-University of Utah (U03MC00008), GLEMSCRN-Nationwide Children’s Hospital (U03MC00003), HOMERUN-Cincinnati Children’s Hospital Medical Center (U03MC22684), PEMNEWS-Columbia University Medical Center (U03MC00007), PRIME-University of California at Davis Medical Center (U03MC00001), SW NODE-University of Arizona Health Sciences Center (U03MC28845), WBCARN-Children’s National Medical Center (U03MC00006), and CHaMP-Medical College of Wisconsin (H3MC26201). This protocol is PECARN Protocol Number 032, and has been authored by David Schnadower, M.D., Washington University, for implementation with the PECARN investigators. This study is supported by R01-HD071915 awarded to Washington University (PI:David Schnadower, M.D.) by the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD). Administrative, technical, or material support: Schnadower, Casper, Olsen, Freedman. Supervision: Poonai, Freedman. Conflict of Interest Disclosures: Dr Freedman reported receiving nonfinancial support from Lallemand Health Solutions, the Provincial Laboratory for Public Health, Luminex Corporation, and Copan Italia, and receiving grants from the Canadian Institutes for Health Research and Alberta Children’s Hospital Foundation. Dr Freedman reported providing consulting services to RedHill Biopharma LTD and Takeda Pharmaceutical Company during the conduct of the study. Dr Powell reported receiving grants from the National Institute of Child Health and Human Development (NICHD) via subcontract and grants from the National Institutes of Health (NIH) via subcontract outside the submitted work. Dr Schnadower reported receiving research grants from NIH/NICHD and nonfinancial support from iHealth Inc during the conduct of the study. Dr Casper reported receiving grants from the NICHD and from the Health Resources and Services Administration (HRSA) during the conduct of the study. Dr Roskind reported receiving grants from the NICHD during the conduct of the study. Dr Olsen reported receiving grants from the NICHD during the conduct of the study. Dr Tarr reported receiving grants from Washington University and the NIH during the conduct of the study. Dr Mahajan reported receiving grants from the NICHD during the conduct of the study. Dr Vance reported receiving grants from the NICHD and the NIH during the conduct of the study. Dr Sapien reported receiving grants from the NIH during the conduct of the study and from the HRSA outside the submitted work. Dr O'Connell reported receiving grants from the NIH during the conduct of the study. Dr Bhatt reported receiving grants from the NIH during the conduct of the study.
ASJC Scopus subject areas
- General Medicine