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Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses?
Ann Emerg Med. 2010 May; 55(5):415-22.AE

Abstract

STUDY OBJECTIVE

We evaluate the effect of ondansetron use in cases of suspected gastroenteritis on the proportion of hospital admissions and return visits and assess whether children who receive ondansetron on their initial visit to the pediatric emergency department (ED) for suspected gastroenteritis return with an alternative diagnosis more frequently than those who did not receive ondansetron.

METHODS

This is a retrospective review of visits to 2 tertiary care pediatric EDs with an International Classification of Diseases, Ninth Revision diagnosis of vomiting or gastroenteritis. A logistic regression model was developed to determine the effect of ondansetron use during the initial pediatric ED visit on hospital admission, return to the pediatric ED within 72 hours, and admission on this return visit. For patients who returned within 72 hours and were admitted, hospital discharge records were reviewed. The proportions of alternative diagnoses, defined as a hospital discharge diagnosis that was not a continuation of gastroenteritis or vomiting, were compared between the groups.

RESULTS

During the 3-year study period (2005 to 2007), 34,117 patients met study criteria. Ondansetron was used for 19,857 (58.2%) of these patients on their initial pediatric ED visit. After controlling for differences between the groups, patients who received ondansetron were admitted on their initial visit less often: odds ratio (OR) 0.47 (95% confidence interval [CI] 0.42 to 0.53). However, those who received ondansetron were more likely to return to the pediatric ED within 72 hours (OR 1.45; 95% CI 1.27 to 1.65) and be admitted on the return visit (OR 1.74; 95% CI 1.39 to 2.19). The proportions of alternative diagnoses at hospital discharge were not significantly different in the group that received ondansetron on the initial pediatric ED visit (14.9%) compared with the group that did not (22.4%) (absolute difference 7.5% [95% CI -0.5% to 16.4%).

CONCLUSION

Ondansetron use in the pediatric ED reduces hospital admissions for suspected gastroenteritis and vomiting. However, children who receive ondansetron in the pediatric ED appear more likely to return to the pediatric ED and be admitted on this return visit than their counterparts. Furthermore, the use of ondansetron does not appear to be associated with increased risks of masking serious diagnoses in children.

Authors+Show Affiliations

Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. jesse.sturm@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20031265

Citation

Sturm, Jesse J., et al. "Ondansetron Use in the Pediatric Emergency Department and Effects On Hospitalization and Return Rates: Are We Masking Alternative Diagnoses?" Annals of Emergency Medicine, vol. 55, no. 5, 2010, pp. 415-22.
Sturm JJ, Hirsh DA, Schweickert A, et al. Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses? Ann Emerg Med. 2010;55(5):415-22.
Sturm, J. J., Hirsh, D. A., Schweickert, A., Massey, R., & Simon, H. K. (2010). Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses? Annals of Emergency Medicine, 55(5), 415-22. https://doi.org/10.1016/j.annemergmed.2009.11.011
Sturm JJ, et al. Ondansetron Use in the Pediatric Emergency Department and Effects On Hospitalization and Return Rates: Are We Masking Alternative Diagnoses. Ann Emerg Med. 2010;55(5):415-22. PubMed PMID: 20031265.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses? AU - Sturm,Jesse J, AU - Hirsh,Daniel A, AU - Schweickert,Adam, AU - Massey,Robert, AU - Simon,Harold K, Y1 - 2010/01/19/ PY - 2009/05/12/received PY - 2009/10/08/revised PY - 2009/11/11/accepted PY - 2009/12/25/entrez PY - 2009/12/25/pubmed PY - 2010/5/8/medline SP - 415 EP - 22 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 55 IS - 5 N2 - STUDY OBJECTIVE: We evaluate the effect of ondansetron use in cases of suspected gastroenteritis on the proportion of hospital admissions and return visits and assess whether children who receive ondansetron on their initial visit to the pediatric emergency department (ED) for suspected gastroenteritis return with an alternative diagnosis more frequently than those who did not receive ondansetron. METHODS: This is a retrospective review of visits to 2 tertiary care pediatric EDs with an International Classification of Diseases, Ninth Revision diagnosis of vomiting or gastroenteritis. A logistic regression model was developed to determine the effect of ondansetron use during the initial pediatric ED visit on hospital admission, return to the pediatric ED within 72 hours, and admission on this return visit. For patients who returned within 72 hours and were admitted, hospital discharge records were reviewed. The proportions of alternative diagnoses, defined as a hospital discharge diagnosis that was not a continuation of gastroenteritis or vomiting, were compared between the groups. RESULTS: During the 3-year study period (2005 to 2007), 34,117 patients met study criteria. Ondansetron was used for 19,857 (58.2%) of these patients on their initial pediatric ED visit. After controlling for differences between the groups, patients who received ondansetron were admitted on their initial visit less often: odds ratio (OR) 0.47 (95% confidence interval [CI] 0.42 to 0.53). However, those who received ondansetron were more likely to return to the pediatric ED within 72 hours (OR 1.45; 95% CI 1.27 to 1.65) and be admitted on the return visit (OR 1.74; 95% CI 1.39 to 2.19). The proportions of alternative diagnoses at hospital discharge were not significantly different in the group that received ondansetron on the initial pediatric ED visit (14.9%) compared with the group that did not (22.4%) (absolute difference 7.5% [95% CI -0.5% to 16.4%). CONCLUSION: Ondansetron use in the pediatric ED reduces hospital admissions for suspected gastroenteritis and vomiting. However, children who receive ondansetron in the pediatric ED appear more likely to return to the pediatric ED and be admitted on this return visit than their counterparts. Furthermore, the use of ondansetron does not appear to be associated with increased risks of masking serious diagnoses in children. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/20031265/Ondansetron_use_in_the_pediatric_emergency_department_and_effects_on_hospitalization_and_return_rates:_are_we_masking_alternative_diagnoses L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(09)01736-3 DB - PRIME DP - Unbound Medicine ER -