Related Experiment Video
Updated: Nov 5, 2025
Modified Most Probable Number Assay to Quantify Salmonella in Raw and Ready-to-Cook Chicken Products
Published on: January 31, 2025
Comparing Pediatric Gastroenteritis Emergency Department Care in Canada and the United States
Stephen B Freedman1, Cindy G Roskind2, Suzanne Schuh3
1Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; stephen.freedman@ahs.ca.
Insights
Children with gastroenteritis had similar revisit rates across US and Canadian emergency departments (EDs). However, US EDs used more intravenous rehydration and hospitalizations, despite similar illness severity.
Area of Science:
- Pediatric Emergency Medicine
- Comparative Health Services Research
Background:
- Disentangling healthcare resource utilization and outcomes from illness severity in acute care is challenging.
- Administrative data limitations hinder accurate comparisons of between-country healthcare practices.
- Patient-level data offers a more granular approach to understanding variations in care.
Purpose of the Study:
- To compare healthcare resource use and outcomes in children with gastroenteritis between US and Canadian emergency departments.
- To investigate variations in intravenous fluid administration and hospitalization rates.
- To assess unscheduled healthcare provider visits within 7 days post-emergency department encounter.
Main Methods:
- A preplanned analysis of patient-level emergency department data from two clinical trials.
- Inclusion of children aged 3 to <48 months with gastroenteritis treated in US and Canadian pediatric emergency departments.
- Primary outcome: unscheduled healthcare provider visit within 7 days. Secondary outcomes: intravenous fluid administration and hospitalization.
Main Results:
- Unscheduled revisits within 7 days did not differ significantly between the US and Canada (aOR: 0.72; 95% CI: 0.50 to 1.02).
- Intravenous fluid administration was more frequent in the US (aOR: 4.6; 95% CI: 2.9 to 7.1) despite Canadian patients having higher assessed dehydration.
- Hospitalization at the index visit was more common in the US (aOR: 3.2; 95% CI: 1.6 to 6.8), though 7-day post-enrollment hospitalization rates did not differ.
Conclusions:
- Children with similar gastroenteritis severity exhibited comparable revisit rates in US and Canadian emergency departments.
- Canadian emergency departments utilized lower rates of intravenous rehydration and hospitalization compared to US counterparts.
- Findings suggest potential variations in clinical practice patterns between countries for pediatric gastroenteritis management.
Background:
Between-country variation in health care resource use and its impact on outcomes in acute care settings have been challenging to disentangle from illness severity by using administrative data.
Methods:
We conducted a preplanned analysis employing patient-level emergency department (ED) data from children enrolled in 2 previously conducted clinical trials. Participants aged 3 to <48 months with <72 hours of gastroenteritis were recruited in pediatric EDs in the United States (N = 10 sites; 588 participants) and Canada (N = 6 sites; 827 participants). The primary outcome was an unscheduled health care provider visit within 7 days; the secondary outcomes were intravenous fluid administration and hospitalization at or within 7 days of the index visit.
Results:
In adjusted analysis, unscheduled revisits within 7 days did not differ (adjusted odds ratio [aOR]: 0.72; 95% confidence interval (CI): 0.50 to 1.02). At the index ED visit, although participants in Canada were assessed as being more dehydrated, intravenous fluids were administered more frequently in the United States (aOR: 4.6; 95% CI: 2.9 to 7.1). Intravenous fluid administration rates did not differ after enrollment (aOR: 1.4; 95% CI: 0.7 to 2.8; US cohort with Canadian as referent). Overall, intravenous rehydration was higher in the United States (aOR: 3.8; 95% CI: 2.5 to 5.7). Although hospitalization rates during the 7 days after enrollment (aOR: 1.1; 95% CI: 0.4 to 2.6) did not differ, hospitalization at the index visit was more common in the United States (3.9% vs 2.3%; aOR: 3.2; 95% CI: 1.6 to 6.8).
Conclusions:
Among children with gastroenteritis and similar disease severity, revisit rates were similar in our 2 study cohorts, despite lower rates of intravenous rehydration and hospitalization in Canadian-based EDs.
