Successful discharge of children with gastroenteritis requiring intravenous rehydration

Stephen B Freedman; Julie M DeGroot; Patricia C Parkin

doi:10.1016/j.jemermed.2013.04.044

Successful discharge of children with gastroenteritis requiring intravenous rehydration

J Emerg Med. 2014 Jan;46(1):9-20. doi: 10.1016/j.jemermed.2013.04.044. Epub 2013 Aug 30.

Authors

Stephen B Freedman¹, Julie M DeGroot², Patricia C Parkin³

Affiliations

¹ Division of Paediatric Emergency Medicine and Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The Paediatric Outcomes Research Team, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
³ Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The Paediatric Outcomes Research Team, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

PMID: 23993936
DOI: 10.1016/j.jemermed.2013.04.044

Abstract

Background: Emergency Department (ED) revisits are very common in children with gastroenteritis administered intravenous rehydration.

Study objectives: To determine if bicarbonate values are associated with ED revisits in children with gastroenteritis.

Methods: We conducted a secondary analysis of prospectively collected data, which included children >3 months of age with gastroenteritis treated with intravenous rehydration. Regression analysis was employed to determine whether, among discharged children, bicarbonate independently predicts revisits within 7 days (primary outcome) and successful discharge (secondary outcome). The latter composite outcome measure was defined as discharge at the index visit and the absence of a revisit requiring intravenous rehydration.

Results: Of 226 potentially eligible children, 174 were discharged and were included in the primary outcome analysis. Of the eligible children, 18% (30/174) had a revisit that was predicted by a higher baseline bicarbonate (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.0-1.3; p = 0.03), absence of a primary care provider (OR 7.8; 95% CI 1.2-51.0; p = 0.03), and ondansetron administration (OR 2.4; 95% CI 1.0-5.5; p = 0.05). Bicarbonate was not associated with successful discharge. Negatively associated independent predictors of successful discharge were volume of intravenous fluids administered (OR 0.84/10 mL/kg increase; 95% CI 0.76-0.93; p < 0.001), and baseline clinical dehydration score (OR 0.75/unit increase; 95% CI 0.58-0.97; p < 0.001). Revisits requiring intravenous rehydration and hospitalization were associated with higher bicarbonate values (21.2 ± 4.6 mEq, p = 0.001, and 22.3 ± 5.0 mEq/L, p < 0.001, respectively).

Conclusion: Lower serum bicarbonate values at the time of intravenous rehydration are not associated with unfavorable outcomes after discharge.

Trial registration: ClinicalTrials.gov NCT00392145.

Keywords: acidosis; ambulatory care facilities; emergencies; gastroenteritis; intravenous infusions.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Administration, Intravenous
Antiemetics / therapeutic use
Bicarbonates / blood*
Biomarkers / blood
Child
Child, Preschool
Dehydration / blood*
Dehydration / etiology
Dehydration / therapy*
Emergency Service, Hospital
Fluid Therapy*
Gastroenteritis / complications*
Humans
Infant
Ondansetron / therapeutic use
Patient Discharge*
Predictive Value of Tests
Primary Health Care
Recurrence
Severity of Illness Index

Substances

Antiemetics
Bicarbonates
Biomarkers
Ondansetron

Associated data

ClinicalTrials.gov/NCT00392145