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LO34: Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

Published online by Cambridge University Press:  02 May 2019

N. Poonai*
Affiliation:
Western University, London, ON
E. Powell
Affiliation:
Western University, London, ON
D. Schnadower
Affiliation:
Western University, London, ON
T. Casper
Affiliation:
Western University, London, ON
C. Roskind
Affiliation:
Western University, London, ON
C. Olsen
Affiliation:
Western University, London, ON
P. Tarr
Affiliation:
Western University, London, ON
P. Mahajan
Affiliation:
Western University, London, ON
A. Rogers
Affiliation:
Western University, London, ON
S. Schuh
Affiliation:
Western University, London, ON
K. Hurley
Affiliation:
Western University, London, ON
S. Gouin
Affiliation:
Western University, London, ON
C. Vance
Affiliation:
Western University, London, ON
K. Farion
Affiliation:
Western University, London, ON
R. Sapien
Affiliation:
Western University, London, ON
K. O'Connell
Affiliation:
Western University, London, ON
A. Levine
Affiliation:
Western University, London, ON
S. Bhatt
Affiliation:
Western University, London, ON
S. Freedman
Affiliation:
Western University, London, ON
on behalf of Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN)
Affiliation:
Western University, London, ON

Abstract

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Introduction: Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. A better understanding of the factors associated with IV rehydration is needed to inform knowledge translation strategies. Methods: This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3-48 months and reported > 3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a priori risk factors. Results: From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5-11.8); severe (OR: 45.9, 95% CI: 20.1-104.7), P < 0.001], ondansetron in the ED (OR: 1.8, CI: 1.2-2.6, P = 0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3-2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2-34.8), P < 0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3-7.4, P < 0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P < 0.001]. Conclusion: Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

Type
Oral Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2019