Persistent Vomiting Among Children With Acute Gastroenteritis: A Secondary Analysis of a Randomized Clinical Trial

Area of Science:

• Pediatric Emergency Medicine
• Gastroenterology
• Clinical Pharmacology

Background:

• Children with acute gastroenteritis-associated vomiting treated in emergency departments (EDs) can benefit from home ondansetron.
• However, predicting which children will experience persistent vomiting post-discharge is crucial for targeted treatment.

Purpose of the Study:

• To identify characteristics predicting 3 or more vomiting episodes within 24 hours of ED discharge in pediatric patients.
• To develop a prognostic score for persistent vomiting.

Main Methods:

• Secondary analysis of a randomized clinical trial involving children aged 6 months to 18 years with acute gastroenteritis-associated vomiting.
• Prognostic score derived using generalized linear mixed models.
• Follow-up for 7 days post-discharge.

Main Results:

• 8.6% of children experienced 3 or more vomiting episodes within 24 hours of discharge.
• Younger age (6 months to <2 years), symptom duration (24-48 hours), and high pre-ED vomiting frequency (≥10 episodes) were associated with post-discharge vomiting.
• A prognostic score of 4+ predicted persistent vomiting with 50% sensitivity and 70% specificity.

Conclusions:

• Younger children with prolonged symptoms and frequent vomiting prior to ED presentation are at higher risk for persistent vomiting after discharge.
• These high-risk children are most likely to benefit from ondansetron for home use.
• This aids in optimizing ondansetron use for pediatric acute gastroenteritis-associated vomiting.