Variables Associated With Intravenous Rehydration and Hospitalization in Children With Acute Gastroenteritis
Authors: Naveen Poonai, Elizabeth C. Powell, David Schnadower, T. Charles Casper, Cindy G. Roskind, Cody S. Olsen, Phillip I. Tarr, Prashant Mahajan, Alexander J. Rogers, Suzanne Schuh, Katrina F. Hurley, Serge Gouin, Cheryl Vance, Ken J. Farion, Robert E. Sapien, Karen J. O’Connell, Adam C. Levine, Seema Bhatt, Stephen B. Freedman
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Despite guidelines endorsing oral rehydration therapy, intravenous fluids are commonly administered to children with acute gastroenteritis in high-income countries. <h3>Objective</h3> To identify factors associated with intravenous fluid administration and hospitalization in children with acute gastroenteritis. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> 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. <h3>Main Outcomes and Measures</h3> Intravenous fluid administration and hospitalization. <h3>Results</h3> 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). <h3>Conclusions and Relevance</h3> 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. <h3>Trial Registration</h3> ClinicalTrials.gov Identifiers:NCT01853124(PERC) andNCT01773967(PECARN)