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Predictors of Hospital Admissions and Return Visits in Children with Suspected Dehydration Presenting to the
Rasha D Sawaya1, Sarah S Abdul-Nabi2, Ola El Kebbi2
1Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Children's Health Ireland at Temple Street, Dublin, Ireland.
Insights
Dehydration in children visiting the emergency department is common. Key predictors for hospital admission include dehydration severity, IV fluids, antibiotics, and low bicarbonate levels, aiding faster clinical decisions.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Chemistry
- Public Health
Background:
- Dehydration is a leading reason for pediatric emergency department (PED) visits.
- Understanding predictors of hospital admission and return visits (RV) is crucial for efficient patient management.
Purpose of the Study:
- To identify factors predicting hospital admission for pediatric patients with dehydration.
- To determine predictors of return visits (RV) to the PED for dehydration.
- To investigate the relationship between dehydration and serum bicarbonate (HCO3) levels.
Main Methods:
- A prospective cohort study was conducted in a tertiary center from November 2018 to March 2020.
- Included were 324 pediatric patients (<18 years) presenting with all-cause dehydration.
- Primary outcomes were hospital admission and secondary outcome was RV; serum bicarbonate (HCO3) was measured, and bivariate/multivariate analyses were performed.
Main Results:
- Hospital admission predictors included dehydration >5% (aOR=2.9), ≥1 IV fluid bolus (aOR=5.4), antibiotics (aOR=11.92), and HCO3 ≤16 mmol/L (aOR=4.4).
- Admitted patients had significantly lower mean HCO3 levels (19.94 vs. 20.98 mmol/L, p=0.017).
- Dry mucous membranes predicted RV (p=0.023), while antipyretics/analgesics were associated (p=0.03), but no significant predictors for RV were identified in multivariate analysis.
Conclusions:
- No significant predictors for return visits (RV) to the PED were identified.
- Serum bicarbonate ≤16 mmol/L, dehydration >5%, IV fluid bolus, and PED antibiotics are associated with increased hospital admission.
- These findings may assist clinicians in making timely disposition decisions for dehydrated pediatric patients.
Background:
Dehydration is a primary cause of visits to pediatric emergency departments (PED).
Objectives:
1) To identify predictors of hospital admission and return visits (RV) in PED patients with all-cause dehydration. 2) To explore the association between dehydration and serum bicarbonate (HCO3) levels.
Methods:
This single-center prospective cohort study included patients under 18 years with dehydration from any cause, presenting to the PED of a tertiary center from November 2018 to March 2020. The primary outcome was hospital admission; the secondary outcome was RV to the PED. HCO3 was measured for all visits. Bivariate and multivariate analyses were conducted.
Results:
The study included 324 patients: most with mild dehydration (199/324, 61%). Of these, 74 (22.8%) were admitted, while 250 (77%) were discharged, 25 of which (10.8%) returned to the PED. Predictors of hospital admission included physician-estimated dehydration >5% (adjusted odds ratio [aOR] = 2.9; 95% CI: 1.5-5.8), ≥1 intravenous (IV) fluid bolus (aOR = 5.4; 95% CI: 1.2-23.8), antibiotics (aOR = 11.92; 95% CI: 3.4-35.5), and HCO3 ≤16 mmol/L (aOR = 4.4; 95% CI: 1.3-14.7). Admitted patients had lower mean HCO3 levels (19.94 ± 3.38 mmol/L vs. 20.98 ± 2.65 mmol/L, p = 0.017). Dry mucous membranes at the index visit were the only significant predictor of RV (12% vs. 35.5%, p = 0.023). Antipyretics/analgesics were associated with RV (76% vs. 51.9%, p = 0.03). Gastritis was inversely associated (4.0% vs. 22.3%, p = 0.03) with RV, but these were nonsignificant in multivariate analysis.
Conclusion:
In this PED cohort, we found no predictors for RV to the PED. However, HCO3 ≤16 mmol/L, physician-estimated dehydration >5%, ≥1 IV fluid bolus, and PED antibiotics were associated with increase hospital admission. If replicated, these findings can help clinicians make faster disposition decisions when caring for dehydrated pediatric patients.
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