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Variables Associated With Intravenous Rehydration and Hospitalization in Children With Acute Gastroenteritis: A Secondary Analysis of 2 Randomized Clinical Trials.
JAMA Netw Open. 2021 04 01; 4(4):e216433.JN

Abstract

Importance

Despite guidelines endorsing oral rehydration therapy, intravenous fluids are commonly administered to children with acute gastroenteritis in high-income countries.

Objective

To identify factors associated with intravenous fluid administration and hospitalization in children with acute gastroenteritis.

Design, Setting, and Participants

This study is a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) probiotic trials. Participants include children aged 3 to 48 months with 3 or more watery stools in 24 hours between November 5, 2013, and April 7, 2017, for the PERC study and July 8, 2014, and June 23, 2017, for the PECARN Study. Children were from 16 pediatric emergency departments throughout Canada (6) and the US (10). Data were analyzed from November 2, 2018, to March 16, 2021.

Exposures

Sex, age, preceding health care visit, distance between home and hospital, country (US vs Canada), frequency and duration of vomiting and diarrhea, presence of fever, Clinical Dehydration Scale score, oral ondansetron followed by oral rehydration therapy, and infectious agent.

Main Outcomes and Measures

Intravenous fluid administration and hospitalization.

Results

This secondary analysis of 2 randomized clinical trials included 1846 children (mean [SD] age, 19.1 [11.4] months; 1007 boys [54.6%]), of whom 534 of 1846 (28.9%) received oral ondansetron, 240 of 1846 (13.0%) received intravenous rehydration, and 67 of 1846 (3.6%) were hospitalized. The following were independently associated with intravenous rehydration: higher Clinical Dehydration Scale 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); prior 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 were independently associated with hospitalization: higher Clinical Dehydration Scale 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 was associated with reduced odds of intravenous rehydration (OR, 0.21; 95% CI, 0.13-0.32) and hospitalization (OR, 0.44; 95% CI, 0.21-0.89).

Conclusions and Relevance

Intravenous rehydration and hospitalization were associated with clinical evidence of dehydration and lack of an oral ondansetron-supported oral rehydration period. Strategies focusing on oral ondansetron administration followed by oral rehydration therapy in children with dehydration may reduce the reliance on intravenous rehydration and hospitalization.

Trial Registration

ClinicalTrials.gov Identifiers: NCT01853124 (PERC) and NCT01773967 (PECARN).

Authors+Show Affiliations

Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Canada. Department of Internal Medicine, Schulich School of Medicine and Dentistry, London, Canada. Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, London, Canada. Children's Health Research Institute, London Health Sciences Centre, London, Canada.Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.Department of Pediatrics, University of Utah, Salt Lake City.Department of Emergency Medicine, Columbia University College of Physicians & Surgeons, New York, New York.Department of Pediatrics, University of Utah, Salt Lake City.Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri.Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit. Wayne State University, Detroit, Michigan. Department of Emergency Medicine, University of Michigan, Ann Arbor.Department of Emergency Medicine, University of Michigan, Ann Arbor.Division of Pediatric Emergency Medicine, The Hospital for Sick Children, SickKids Research Institute, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada.Department of Pediatric Emergency Medicine, Université de Montréal, Montréal, Quebec, Canada. Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada.Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento. Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento.Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada. Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada. Pediatric Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.Department of Emergency Medicine, University of New Mexico, Albuquerque.Division of Emergency Medicine, Children's National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC.Department of Emergency Medicine, Rhode Island Hospital/Hasbro Children's Hospital and Brown University, Providence.Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatric Medicine, Alberta Children's Hospital, Alberta, Canada. Section of Pediatric Emergency Medicine, Department of Emergency Medicine, Alberta Children's Hospital, Alberta, Canada. Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.No affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

33871616

Citation

Poonai, Naveen, et al. "Variables Associated With Intravenous Rehydration and Hospitalization in Children With Acute Gastroenteritis: a Secondary Analysis of 2 Randomized Clinical Trials." JAMA Network Open, vol. 4, no. 4, 2021, pp. e216433.
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. 2021;4(4):e216433.
Poonai, N., Powell, E. C., Schnadower, D., Casper, T. C., Roskind, C. G., Olsen, C. S., Tarr, P. I., Mahajan, P., Rogers, A. J., Schuh, S., Hurley, K. F., Gouin, S., Vance, C., Farion, K. J., Sapien, R. E., O'Connell, K. J., Levine, A. C., Bhatt, S., & Freedman, S. B. (2021). Variables Associated With Intravenous Rehydration and Hospitalization in Children With Acute Gastroenteritis: A Secondary Analysis of 2 Randomized Clinical Trials. JAMA Network Open, 4(4), e216433. https://doi.org/10.1001/jamanetworkopen.2021.6433
Poonai N, 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. 2021 04 1;4(4):e216433. PubMed PMID: 33871616.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variables Associated With Intravenous Rehydration and Hospitalization in Children With Acute Gastroenteritis: A Secondary Analysis of 2 Randomized Clinical Trials. AU - Poonai,Naveen, AU - Powell,Elizabeth C, AU - Schnadower,David, AU - Casper,T Charles, AU - Roskind,Cindy G, AU - Olsen,Cody S, AU - Tarr,Phillip I, AU - Mahajan,Prashant, AU - Rogers,Alexander J, AU - Schuh,Suzanne, AU - Hurley,Katrina F, AU - Gouin,Serge, AU - Vance,Cheryl, AU - Farion,Ken J, AU - Sapien,Robert E, AU - O'Connell,Karen J, AU - Levine,Adam C, AU - Bhatt,Seema, AU - Freedman,Stephen B, AU - ,, Y1 - 2021/04/01/ PY - 2021/4/19/entrez PY - 2021/4/20/pubmed PY - 2021/8/25/medline SP - e216433 EP - e216433 JF - JAMA network open JO - JAMA Netw Open VL - 4 IS - 4 N2 - Importance: Despite guidelines endorsing oral rehydration therapy, intravenous fluids are commonly administered to children with acute gastroenteritis in high-income countries. Objective: To identify factors associated with intravenous fluid administration and hospitalization in children with acute gastroenteritis. Design, Setting, and Participants: This study is a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) probiotic trials. Participants include children aged 3 to 48 months with 3 or more watery stools in 24 hours between November 5, 2013, and April 7, 2017, for the PERC study and July 8, 2014, and June 23, 2017, for the PECARN Study. Children were from 16 pediatric emergency departments throughout Canada (6) and the US (10). Data were analyzed from November 2, 2018, to March 16, 2021. Exposures: Sex, age, preceding health care visit, distance between home and hospital, country (US vs Canada), frequency and duration of vomiting and diarrhea, presence of fever, Clinical Dehydration Scale score, oral ondansetron followed by oral rehydration therapy, and infectious agent. Main Outcomes and Measures: Intravenous fluid administration and hospitalization. Results: This secondary analysis of 2 randomized clinical trials included 1846 children (mean [SD] age, 19.1 [11.4] months; 1007 boys [54.6%]), of whom 534 of 1846 (28.9%) received oral ondansetron, 240 of 1846 (13.0%) received intravenous rehydration, and 67 of 1846 (3.6%) were hospitalized. The following were independently associated with intravenous rehydration: higher Clinical Dehydration Scale 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); prior 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 were independently associated with hospitalization: higher Clinical Dehydration Scale 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 was associated with reduced odds of intravenous rehydration (OR, 0.21; 95% CI, 0.13-0.32) and hospitalization (OR, 0.44; 95% CI, 0.21-0.89). Conclusions and Relevance: Intravenous rehydration and hospitalization were associated with clinical evidence of dehydration and lack of an oral ondansetron-supported oral rehydration period. Strategies focusing on oral ondansetron administration followed by oral rehydration therapy in children with dehydration may reduce the reliance on intravenous rehydration and hospitalization. Trial Registration: ClinicalTrials.gov Identifiers: NCT01853124 (PERC) and NCT01773967 (PECARN). SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/33871616/Variables_Associated_With_Intravenous_Rehydration_and_Hospitalization_in_Children_With_Acute_Gastroenteritis:_A_Secondary_Analysis_of_2_Randomized_Clinical_Trials_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2021.6433 DB - PRIME DP - Unbound Medicine ER -