scholarly journals LO34: Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S19
Author(s):  
N. Poonai ◽  
E. Powell ◽  
D. Schnadower ◽  
T. Casper ◽  
C. Roskind ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Acute Gastroenteritis ◽  
A Priori ◽  
Secondary Analysis ◽  
Oral Rehydration Therapy ◽  
The United States ◽  
Pediatric Emergency ◽  
Research Network ◽  
Oral Rehydration ◽  
Knowledge Translation Strategies

Introduction: Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. A better understanding of the factors associated with IV rehydration is needed to inform knowledge translation strategies. Methods: This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3-48 months and reported > 3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a priori risk factors. Results: From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5-11.8); severe (OR: 45.9, 95% CI: 20.1-104.7), P < 0.001], ondansetron in the ED (OR: 1.8, CI: 1.2-2.6, P = 0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3-2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2-34.8), P < 0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3-7.4, P < 0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P < 0.001]. Conclusion: Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

scholarly journals 118 Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

2019 ◽  
Vol 24 (Supplement_2) ◽  
pp. e45-e45
Author(s):  
Naveen Poonai ◽  
Elizabeth C Powell ◽  
David Schnadower ◽  
Charlie Casper ◽  
Cindy Roskind ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Acute Gastroenteritis ◽  
Secondary Analysis ◽  
Oral Rehydration Therapy ◽  
The United States ◽  
Pediatric Emergency ◽  
Research Network ◽  
Oral Rehydration ◽  
Intravenous Rehydration ◽  
Knowledge Translation Strategies

Abstract Background Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. Objectives We sought to better understand the factors associated with IV rehydration in children with AGE in order to inform knowledge translation strategies. Design/Methods This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3–48 months and reported >3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a prioririsk factors. Results From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5–11.8); severe (OR: 45.9, 95% CI: 20.1–104.7), P<0.001], ondansetron in the ED (OR: 1.8, CI: 1.2–2.6, P=0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3–2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2–34.8), P<0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3–7.4, P<0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P<0.001]. Conclusion Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

Knowledge translation activity of a domestic violence research network: a scoping survey

2021 ◽  
Author(s):  
Jacqui Cameron ◽  
Cathy Humphreys ◽  
Kelsey Hegarty
Keyword(s):  
Domestic Violence ◽  
Knowledge Translation ◽  
Lived Experience ◽  
Online Survey ◽  
Research Process ◽  
Research Network ◽  
Translation Strategies ◽  
Inadequate Knowledge ◽  
Knowledge Translation Strategies ◽  
Research Findings

Introduction: Research networks undertake work collaboratively on complex areas of research. Few studies examine how these networks develop their knowledge translation activity. Focusing on a domestic violence research network (DVRN), the aim of this study was to answer the question: What is the shared understanding of knowledge translation and activity in a domestic violence research network?Methods: A sample of DVRN members undertook an anonymous online survey about their knowledge translation activity.Results: Completed by 49 of a potential 65 DVRN members (75% completion rate), findings suggested members use multiple knowledge translation definitions, and that different stages of the research process engage people with lived-experience and policymakers undertaking lower levels of engagement than practitioners. Innovative engagement mechanisms to communicate research findings were limited, and knowledge translation barriers included budget, time, capacity, limitation of models, organisational emphasis and support. Finally, there was inadequate knowledge translation evaluation.Conclusion: Overcoming knowledge translation barriers is essential to ensure meaningful collaboration particularly with survivors who are often the missing voice of knowledge translation. Future studies could determine what impact, if any, increasing engagement of survivors and policymakers during all stages of the research process has on knowledge translation.<br />Key messages<br /><ul><li>This study has identified the need for meaningful collaboration with survivors and policymakers during all stages of the research process.</li><br /><li>Innovative engagement mechanisms are essential to engage end-users.</li><br /><li>A focus on evaluation of knowledge translation strategies is warranted.</li></ul>

The Pediatric Emergency Care Applied Research Network and Knowledge Translation

2018 ◽  
Vol 19 (3) ◽  
pp. 295-303 ◽  
Author(s):  
Rachel M. Stanley ◽  
Mona Jabbour ◽  
Jessica M. Saunders ◽  
Sally Jo Zuspan
Keyword(s):  
Knowledge Translation ◽  
Emergency Care ◽  
Applied Research ◽  
Pediatric Emergency ◽  
Research Network ◽  
Pediatric Emergency Care

Traumatic brain injury in young children with isolated scalp haematoma

2019 ◽  
Vol 104 (7) ◽  
pp. 664-669 ◽  
Author(s):  
Silvia Bressan ◽  
Amit Kochar ◽  
Ed Oakley ◽  
Meredith Borland ◽  
Natalie Phillips ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Young Children ◽  
Ct Scan ◽  
Head Trauma ◽  
Secondary Analysis ◽  
Predictor Variable ◽  
Pediatric Emergency ◽  
Research Network ◽  
Registration Number

ObjectiveDespite high-quality paediatric head trauma clinical prediction rules, the management of otherwise asymptomatic young children with scalp haematomas (SH) can be difficult. We determined the risk of intracranial injury when SH is the only predictor variable using definitions from the Pediatric Emergency Care Applied Research Network (PECARN) and Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) head trauma rules.DesignPlanned secondary analysis of a multicentre prospective observational study.SettingTen emergency departments in Australia and New Zealand.PatientsChildren <2 years with head trauma (n=5237).InterventionsWe used the PECARN (any non-frontal haematoma) and CHALICE (>5 cm haematoma in any region of the head) rule-based definition of isolated SH in both children <1 year and <2 years.Main outcome measuresClinically important traumatic brain injury (ciTBI; ie, death, neurosurgery, intubation >24 hours or positive CT scan in association with hospitalisation ≥2 nights for traumatic brain injury).ResultsIn children <1 year with isolated SH as per PECARN rule, the risk of ciTBI was 0.0% (0/109; 95% CI 0.0% to 3.3%); in those with isolated SH as defined by the CHALICE, it was 20.0% (7/35; 95% CI 8.4% to 36.9%) with one patient requiring neurosurgery. Results for children <2 years and when using rule specific outcomes were similar.ConclusionsIn young children with SH as an isolated finding after head trauma, use of the definitions of both rules will aid clinicians in determining the level of risk of ciTBI and therefore in deciding whether to do a CT scan.Trial registration numberACTRN12614000463673.

scholarly journals Parents’ Attitudes toward Oral Rehydration Therapy in Children with Mild-to-Moderate Dehydration

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Vered Nir ◽  
Erez Nadir ◽  
Yaffa Schechter ◽  
Adi Kline-Kremer
Keyword(s):  
Nasogastric Tube ◽  
Oral Treatment ◽  
Oral Rehydration Therapy ◽  
Pediatric Emergency ◽  
Second Line ◽  
First Line ◽  
Clinical Appearance ◽  
Oral Rehydration ◽  
Previously Treated ◽  
Current Guidelines

Objective. According to current guidelines, the first line of treatment for mild-to-moderate dehydration is oral rehydration; the second line is rehydration through a nasogastric tube. Both methods are widely underused. This study was conducted to evaluate parents’ attitudes towards rehydration methods used in pediatric emergency departments.Design. 100 questionnaires were distributed to parents of children who visited emergency room due to gastroenteritis and suspected dehydration.Results. 75 of the parents expected their child to get IV fluids. 49 of them would refuse to consider oral rehydration. 75 of the parents would refuse to consider insertion of nasogastric tube. Parents whose children were previously treated intravenously tended to be less likely to agree to oral treatment. Parents were more prone to decline oral rehydration if the main measurement of dehydration was the child’s clinical appearance, clinical appearance with vomiting, or child’s refusal to drink and were more likely to agree if the main measurement was diarrhea, diarrhea with clinical appearance, or clinical personnel opinion.Conclusions. This is the first study to examine parents’ expectations. We found that in the majority of cases, parents’ expectations contradict current guidelines. Efforts should be taken to educate parents in order to allow full implementation of the guidelines.

scholarly journals An Audit on the implementation of administering Ondansetron in children with acute gastroenteritis and its effect on admission rate

2021 ◽  
Vol 4 (1) ◽  
pp. 023-026
Author(s):  
D’Sa Saskia ◽  
Hussain Ahad ◽  
Hussain Mushtaq ◽  
Afridi Zahir ◽  
Twomey John ◽  
...  
Keyword(s):  
Acute Gastroenteritis ◽  
Oral Intake ◽  
Admission Rate ◽  
Cost Effective ◽  
Oral Rehydration Therapy ◽  
University Hospital ◽  
Oral Hydration ◽  
Effective Measure ◽  
Oral Rehydration ◽  
Admission Rates

Acute gastroenteritis (AGE) is a common presenting complaint in paediatrics. Most often, the reason for admission into hospital is to initiate intravenous rehydration in patients with severe dehydration and inability to tolerate oral intake. We found that Ondansetron acts as a potent antiemetic to support an increased number of children receiving oral hydration, and subsequently leading to decreased rates of admission. This study aims to audit the use of Ondansetron to Oral Rehydration Therapy (ORT) on children with acute gastroenteritis, and its effect on admission rates from the emergency department in University Hospital, Limerick (UHL). Data collected over a 3-month period from June to August 2017 in which Ondansetron was not used was compared to another 3-month period when Ondansetron was used. Several outcomes were measured including admission to hospital. The rate of admission decreased by 15% [26/74 (35%) in 2017 to 16/81 (20%) in 2019 p = 0.22]. 81 patients received Ondansetron, of which 79% were successfully rehydrated orally. The administration of Ondansetron reduced the need for intravenous fluids and hospital admission overall in these children with AGE. This reduction ultimately accounted for lower costs incurred by the Health Services Executive per patient, and also suggested the anti-emetic use as a cost effective measure for managing and treating patients with AGE.

scholarly journals The effect of oral ondansetron on QT interval in children with acute gastroenteritis; a retrospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heewon Yang ◽  
Woochan Jeon ◽  
Yura Ko ◽  
Sooin Jeong ◽  
Jisook Lee
Keyword(s):  
Observational Study ◽  
Acute Gastroenteritis ◽  
Qt Interval ◽  
Pediatric Emergency ◽  
University Hospital ◽  
Retrospective Observational Study ◽  
Cardiac Complications ◽  
Oral Rehydration ◽  
The Mean ◽  
Oral Ondansetron

Abstract Background In mildly to moderately dehydrated patients with acute gastroenteritis (AGE), oral rehydration therapy (ORT) is the treatment of choice. Though ondansetron is a very effective antiemetics and leads to succeed ORT, there have been reports QT prolongation in patients using it. We investigated the effect of oral ondansetron on QT interval in mildly to moderately dehydrated children with AGE. Methods This retrospective observational study was conducted in a single pediatric emergency department (ED) of a tertiary university hospital. We collected the medical records of patients with a primary diagnosis of AGE who received oral ondansetron and underwent an electrocardiogram between January 2017 and June 2018. A pediatric emergency physician calculated the corrected QT interval (QTc) by Bazett’s method, and the calculations were reviewed by a pediatric cardiologist. QTc values before (preQTc) and after (postQTc) ondansetron administration were analyzed. ΔQTc was calculated as the change from preQTc to postQTc. We also investigated any cardiac complications from oral ondansetron. Results Total 80 patients were included. The mean age of the patients was 53.31 ± 32.42 months, and 45% were male. The mean dose of oral ondansetron was 0.18 ± 0.04 mg/kg. The mean interval from administration of ondansetron to performance of the electrocardiogram was 65 ± 26 min. The mean preQTc was 403.3 ± 24.0 ms, and the mean postQTc was 407.2 ± 26.7 ms. Two patients had a preQTc ≥460 ms, and one patient had a postQTc ≥460 ms. ΔQTc was ≥30 ms in seven patients (8.8%). No ΔQTc was ≥60 ms. No pre- or postQTc was ≥500 ms. No patient had a fatal cardiac arrhythmia after taking ondansetron. Conclusion Oral administration of a single dose of ondansetron in children with AGE did not cause high-risk QTc prolongation or fatal arrhythmia.

Sign in / Sign up

Export Citation Format

Share Document