Independent variables associated with intravenous rehydration and hospitalization in children with acute gastroenteritis (AGE) included greater dehydration, care in the United States (US) relative to Canada, increased travel distance to the emergency department, and increased duration of vomiting in the 24 hours prior to emergency department visit. Oral ondansetron followed by oral rehydration therapy (ORT) was associated with reduced odds of both intravenous rehydration and hospitalization in children with AGE. The study authors reported these findings in JAMA Network Open.
Researchers aimed to identify factors associated with intravenous rehydration and hospitalization in children with AGE in the US and Canada.
Investigators conducted a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) (ClinicalTrials.gov identifier: NCT01853124) and Pediatric Emergency Care Applied Research Network (PECARN) (ClinicalTrials.gov identifier: NCT01773967) trials. These were randomized clinical trials of probiotics in children with AGE associated diarrhea.
Study participants consisted of children aged 3 to 48 months with 3 or more watery stools reported within 24 hours. Participants were enrolled from November 5, 2013 to June 23, 2017. The study locations included 16 pediatric emergency departments in Canada (6) and the US (10). The primary outcomes, which were assessed at the index visit, were intravenous rehydration and hospitalization.
A total of 1846 children were included in the secondary analysis of the 2 aforementioned trials. Over half of the enrollees were boys (54.6%), and the mean (SD) age was approximately 19.1 [11.4] months. A total of 534 of 1846 participants (28.9%) received oral ondansetron, 240 of 1846 (13.0%) received intravenous rehydration, and 67 of 1846 (3.6%) were hospitalized.
The following variables were independently associated with intravenous rehydration: higher Clinical Dehydration Scale (CDS) score (mild to moderate vs none, odds ratio [OR], 8.73; 95% CI, 5.81-13.13; and severe vs none, OR, 34.15; 95% CI, 13.45-86.73), country (US vs Canada, OR, 6.76; 95% CI, 3.15- 14.49), previous health care visit with intravenous fluids (OR, 4.55; 95% CI, 1.32-15.72), and frequency of vomiting (per 5 episodes, OR, 1.66; 95% CI, 1.39-1.99).
The following variables were independently associated with hospitalization: higher CDS score (mild to moderate vs none, OR, 11.10; 95% CI, 5.05-24.38; and severe vs none, OR, 23.55; 95% CI, 7.09-78.25) and country (US vs Canada, OR, 3.37; 95% CI, 1.36-8.40).
Oral ondansetron followed by ORT was associated with reduced odds of intravenous rehydration in children with AGE (OR, 0.43; 95% CI, 0.31-0.61), as well as reduced odds of hospitalization (OR, 0.47; 95% CI, 0.25-0.89).
This study had multiple limitations. Participants were only enrolled from high-income countries and only a small proportion were severely dehydrated. Additionally, the researchers were unable to determine the role of other potential risks including insurance status, provider experience, or the ability of child and caregiver to perform ORT. Lastly, parental expectations were not described, though investigators acknowledge these expectations have the potential to influence clinical decision-making.
These findings suggest that oral ondansetron followed by ORT has the potential to reduce intravenous rehydration and hospitalization rates in children with AGE.
Disclosure: Some study authors declared affiliations with the industry. Please see the original reference for a full list of authors’ disclosures. Additionally, this research was supported by multiple sources. Please see the original reference for a full list of disclosures.
Poonai N, Powell EC, Schnadower D, et al. Variables associated with intravenous rehydration and hospitalization in children with acute gastroenteritis: a secondary analysis of 2 randomized clinical trials. JAMA Netw Open. Published online April 19, 2021. doi: 10.1001/jamanetworkopen.2021.6433