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.

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 LO80: Ondansetron administration to non-dehydrated children with acute gastroenteritis-associated vomiting, in emergency departments in Pakistan: a randomized, blinded, phase 3, superiority trial

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S35-S35
Author(s):  
S. Freedman ◽  
S. Soofi ◽  
A. Willan ◽  
S. Williamson-Urquhart ◽  
N. Ali ◽  
...  
Keyword(s):  
Treatment Group ◽  
Acute Gastroenteritis ◽  
Oral Rehydration Therapy ◽  
Fluid Administration ◽  
Double Blind ◽  
Oral Rehydration ◽  
Intravenous Rehydration ◽  
Intravenous Fluid Administration ◽  
Superiority Trial ◽  
Randomization Scheme

Introduction: In high-income countries, vomiting often impedes oral rehydration therapy, leading to intravenous rehydration fluid administration to children with acute gastroenteritis. Ondansetron administration reduces vomiting and intravenous fluid administration in this population. We evaluated whether ondansetron is similarly effective when employed in Pakistan. Methods: In this 2-hospital, double-blind, placebo-controlled, emergency department-based, randomized trial, we recruited children aged 0·5 to 5·0 years, without dehydration, who had diarrhea and 1 episode of vomiting within 4 hours of arrival. Patients were randomly assigned (1:1), via an internet-based randomization service, using a stratified, variable block randomization scheme, to receive a single dose of oral ondansetron or placebo. The primary endpoint was intravenous rehydration (administration of 20 ml/kg over 4 hours of an isotonic fluid) within 72 hours of randomization. All randomized children were analysed. Results: From July 3, 2014, to January 12, 2017, 626 children were randomized. Intravenous rehydration was provided to 10.8% (34/314) and 10.3% (27/312) of children administered placebo and ondansetron, respectively (OR: 0.946; 95% CI: 0.564, 1.587; P=0.834). A regression model fitted with treatment group and adjusted for antiemetic administration and vomiting frequency in the preceding 24 hours, yielded similar results; OR=0.952; 95% CI: 0.570, 1.589; P=0.850. There was no evidence of interaction between treatment group and age (P=0.974), 3 diarrheal stools in the preceding 24 hours (P=0.983) or 3 vomits in the preceding 24 hours (P=0.554). During the 4-hour study observation period, 24.0% (75/314) and 19.6% (61/312) of children in the placebo and ondansetron groups vomited, respectively; OR: 0.774; 95%CI: 0.528, 1.133; P=0.187. Conclusion: Ondansetron administration did not significantly reduce intravenous rehydration use, suggesting that in children without dehydration, ondansetron administration does not significantly alter the disease course and should not be administered to this group of children.

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

scholarly journals An epidemic of cholera due toVibrio choleraeO139 in Dhaka, Bangladesh: clinical and epidemiological features

1994 ◽  
Vol 112 (3) ◽  
pp. 463-471 ◽  
Author(s):  
D. Mahalanabis ◽  
A. S. G. Faruque ◽  
M. J. Albert ◽  
M. A. Salam ◽  
S. S. Hoque
Keyword(s):  
Oral Rehydration Therapy ◽  
Watery Diarrhoea ◽  
Large Hospital ◽  
Oral Rehydration ◽  
Hygiene Practices ◽  
Disease Spectrum ◽  
Intravenous Rehydration ◽  
Epidemiological Features ◽  
History Of ◽  
Culture Positive

SUMMARYWe describe the disease spectrum and socio-demographic and epidemiological features of an epidemic of cholera due to a new pathogen.Vibrio choleraeO139, in patients attending a very large hospital in the metropolitan city of Dhaka, Bangladesh.This hospital treats 70000–90000 patients a year with diarrhoeal diseases. A 4% systematic sample of 1854 patients attending from January to April 1993 were studied.Five hundred and two (27%) of the 1854 patients were culture positive forV. choleraeO139 and 63 (3%) were culture positive forV. choleraeO1 biotype El Tor. Patients withV. choleraeO139 were mainly adults with a short history of watery diarrhoea. Eight-three percent of patients had moderate to severe dehydration. All recovered except one 80-year-old man with compromised renal function who died. Seventy-eight percent of patients required initial intravenous rehydration followed by oral rehydration therapy with rice ORS; they also received tetracycline to reduce diarrhoea severity. Most patients were from urban slums with inadequate sanitation facilities and hygiene practices.The newly recognizedV. choleraeO139 infection produced an epidemic of severe dehydrating diarrhoea indistinguishable from clinical cholera in a population which experiences two epidemic peaks of cholera in a year due toV. choleraeO1. Infection with the latter does not appear to confer any cross-protection fromV. choleraeO139. The new pathogen suppressed, albeit temporarily,V. choleraeO1. Unlike other non-O1 serogroups ofV. choleraethis new serogroup appears to have epidemic potential.

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.

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