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Clinical pathway using rapid rehydration for children with gastroenteritis
S J Phin1, M E McCaskill, G J Browne
1The Emergency Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia. susanp3@chw.edu.au
Insights
A rapid rehydration clinical pathway significantly reduced hospital admissions for moderately dehydrated children with acute gastroenteritis. This approach also increased the number of children discharged from the emergency department within 8 hours.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Clinical Pathway Implementation
Background:
- Acute gastroenteritis is a common cause of dehydration in children presenting to emergency departments.
- Moderate dehydration requires effective and timely management to prevent complications and reduce healthcare resource utilization.
Purpose of the Study:
- To evaluate the efficacy of a clinical pathway employing rapid rehydration for pediatric patients with moderate dehydration due to acute gastroenteritis.
- To assess the impact of this pathway on emergency department admission rates and length of stay.
Main Methods:
- Prospective study with historical controls in a pediatric emergency department.
- Intervention involved a clinical pathway with rapid intravenous or nasogastric rehydration.
- Compared outcomes between 145 children in the intervention group and 170 historical controls.
Main Results:
- The intervention group showed a significantly lower admission rate (55.8% vs. 96.3%) compared to controls.
- A higher percentage of children in the intervention group were discharged within 8 hours (44.2% vs. 3.7%).
- No significant differences were observed in re-presentation rates or procedural rates.
Conclusions:
- A clinical pathway utilizing rapid rehydration is effective for managing moderately dehydrated children with gastroenteritis.
- This pathway successfully reduces emergency department admission rates and shortens patient stays.
- Rapid rehydration strategies can optimize care for pediatric gastroenteritis.
Objective:
To determine in the Emergency Department (ED) the efficacy of a clinical pathway using rapid rehydration for children moderately dehydrated as a result of acute gastroenteritis.
Methods:
This was a prospective study using historical controls, set in the ED of the Children's Hospital at Westmead, NSW, Australia. Subjects were aged from 6 months to 16 years presenting with vomiting and diarrhoea for <48 h who were mildly or moderately dehydrated. The intervention was a clinical pathway involving rapid rehydration using N/2 saline + 2.5% dextrose intravenously at 20 mL/kg per h for 2 h, or Gastrolyte R (Aventis Pharma, Lane Cove, NSW, Australia) via nasogastric tube at the same rate. There were 145 children in the prospective intervention group and 170 in the historical control group. The outcome measures were admission rate, percentage of patients discharged from the ED in 8 h or less, rate of re-presentations within 48 h requiring admission, and rate of procedures with intravenous cannula or nasogastric tube.
Results:
In the moderately dehydrated children, significant reductions were observed in the admission rate and the number discharged in 8 h or less in the intervention group compared with the control group, with no significant difference in the rate of re-presentation and the rate of procedures. In the moderately dehydrated children in the intervention group, the admission rate was 29 of 52 (55.8%) compared with the controls 26 of 27 (96.3%) (P < 0.001) and the number discharged in 8 h or less was 23 of 52 (44.2%) compared with 1 of 27 (3.7%) in the controls (P < 0.01).
Conclusion:
The clinical pathway utilizing rapid rehydration in children moderately dehydrated from gastroenteritis is effective in reducing admission rates and lengths of stay in the ED.