Prospective assessment of practice pattern variations in the treatment of pediatric gastroenteritis
Stephen B Freedman1, Serge Gouin, Maala Bhatt
1Division of Pediatric Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada. stephen.freedman@sickkids.ca
Insights
Intravenous rehydration for acute gastroenteritis in children varied significantly by institution. This treatment was linked to increased follow-up visits and not to reduced need for care.
Area of Science:
- Pediatrics
- Emergency Medicine
- Gastroenterology
Background:
- Acute gastroenteritis is a common pediatric illness.
- Variations in treatment protocols can impact patient outcomes and healthcare resource utilization.
Purpose of the Study:
- To investigate institutional variations in intravenous rehydration and ancillary therapy use for pediatric acute gastroenteritis.
- To identify factors associated with the use of intravenous rehydration.
Main Methods:
- Prospective cohort study involving 647 children aged 3-48 months across 11 emergency departments.
- Data collected via surveys, medical record reviews, and telephone follow-up.
Main Results:
- Significant institutional variation in intravenous rehydration (6%-66%) and ondansetron (0%-38%) use.
- Institution location was the strongest predictor of intravenous rehydration.
- Intravenous rehydration was associated with higher rates of unscheduled follow-up and emergency department revisits.
Conclusions:
- Dramatic variations in intravenous rehydration and ondansetron use were observed.
- Intravenous rehydration use was institution-dependent and did not decrease the need for follow-up care.
Objectives:
We aimed to determine whether significant variations in the use of intravenous rehydration existed among institutions, controlling for clinical variables, and to assess variations in the use of ancillary therapeutic and diagnostic modalities.
Methods:
We conducted a prospective cohort study of children 3 to 48 months of age who presented to 11 emergency departments with acute gastroenteritis, using surveys, medical record reviews, and telephone follow-up evaluations.
Results:
A total of 647 eligible children were enrolled and underwent chart review; 69% (446 of 647 children) participated in the survey, and 89% of survey participants (398 of 446 children) had complete follow-up data. Twenty-three percent (149 of 647 children) received intravenous rehydration (range: 6%-66%; P < .001) and 13% (81 of 647 children) received ondansetron (range: 0%-38%; P < .001). Children who received intravenous rehydration had lower Canadian Triage Acuity Scale scores at presentation (3.1 ± 0.5 vs 3.5 ± 0.5; P < .0001). Regression analysis revealed that the greatest predictor of intravenous rehydration was institution location (odds ratio: 3.0 [95% confidence interval: 1.8-5.0]). Children who received intravenous rehydration at the index visit were more likely to have an unscheduled follow-up health care provider visit (29% vs 19%; P = .05) and to revisit an emergency department (20% vs 9%; P = .002).
Conclusions:
In this cohort, intravenous rehydration and ondansetron use varied dramatically. Use of intravenous rehydration at the index visit was significantly associated with the institution providing care and was not associated with a reduction in the need for follow-up care.
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