Oral rehydration, emergency physicians, and practice parameters: a national survey

Treatment of dehydrating gastroenteritis, a major cause of morbidity in children, remains controversial. Practice parameters issued by the American Academy of Pediatrics (AAP) recommend oral rehydration therapy (ORT) as the preferred treatment for losses from both mild and moderate dehydration. The objective of this study was to test the hypothesis that awareness of the AAP practice parameters would be associated with a higher rate of use of ORT among emergency physicians.

A national random survey of emergency physicians selected from the mailing list of the AAP Section on Emergency Medicine was conducted. Respondents were asked about level of awareness of AAP guidelines and preferred route of rehydration for scenarios representing mild (< or =5%), moderate (6%-9%), and severe (> or =10%) dehydration. Respondents who were very familiar with the AAP practice parameters were designated as the familiar group; those who were less familiar were designated as the unfamiliar group. Differences in proportions of dichotomous variables were tested by chi2 or Fisher exact test as appropriate. Univariate logistic regression modeling was used to determine the independent influence of awareness of AAP guidelines on the use of ORT.

A total of 176 physicians responded (73% response rate). Most were board certified in 1 or more specialties: pediatrics (89%), pediatric emergency medicine (84%), and adult emergency medicine (63%). Median duration of practice was 16 years. Thirty-seven percent of respondents were very familiar with the AAP practice parameters. In contrast to the unfamiliar group, the familiar group was more likely to use ORT in scenarios of mild dehydration (81% vs 66%) and moderate dehydration (25% vs 10%). Logistic regression analysis confirmed that this familiar group overall was nearly 3 times more likely to use ORT (odds ratio: 2.85; 95% confidence interval: 2.46-3.24).

This is the first national study to establish a relationship between awareness of the AAP practice parameters and physician practices in the treatment of dehydration. Emergency medicine physicians who were very familiar with the AAP parameters were significantly more likely to use ORT. These findings may have important implications for future efforts directed at increasing the rate of ORT use and for the evaluation of practice parameters in general.