Ondansetron Prescription Is Associated With Reduced Return Visits to the Pediatric Emergency Department for Children With Gastroenteritis

Benary, Doreen; Lozano, Juan Manuel; Higley, Rebecca; Lowe, David

doi:10.1016/j.annemergmed.2020.04.012

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…En el presente estudio, la frecuencia de reconsultas en el DEP de los pacientes que recibieron en la primera consulta ondansetron, fue dos veces mayor que el (9) 4,7% reportado por Benary y cols en 72 horas . Palnizky y cols, en un estudio retrospectivo, que incluyó 3838 pacientes pediátricos con vómitos tratados con ondansentron, reportó 5,6% reconsultas (7) dentro de los siete días .…”

Section: Discussionunclassified

Diagnósticos retrasados y administración de ondansetron en el tratamiento de los vómitos en urgencias pediátricas

Cabral,

Pavlicich,

Godoy Sánchez

et al. 2024

Pediatr (Asunción).

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Introducción: El ondasentrón es un agente farmacológico de uso frecuente para el tratamiento sintomático de los vómitos originados por gastroenteritis. Sin embargo, podría enmascarar patologías más graves que ameriten reconsultas y hospitalización. Objetivo: Indagar si la administración del ondansetrón como tratamiento sintomático de los vómitos en el departamento de emergencias pediátricas (DEP) retrasó el diagnóstico de patologías graves. Materiales y métodos: Estudio observacional, descriptivo de corte transverso retrospectivo. Fueron elegibles pacientes que consultaron en el DEP, recibieron tratamiento con ondansetron, y reconsultaron dentro de las 24 horas. Los datos fueron recolectados de la base de datos de consultas del DEP, el comando reconsultas y entrevista telefónica a los padres. Las variables fueron edad, sexo, procedencia, motivo de la segunda consulta, diagnósticos finales en la segunda consulta. Los datos fueron analizados en SPSS utilizando estadística descriptiva. Resultados En el periodo de estudio consultaron por vómitos y recibieron ondasentrón 2018 pacientes. Reconsultaron dentro de las 24 horas 212, cumpliendo con los criterios de inclusión 205 pacientes. Se constató un 24,8% nuevos diagnósticos durante la reconsulta, de los cuales 35% requirieron hospitalización. Los diagnósticos fueron fiebre sin foco 2,9%, neumonía 2,4%, infección de vías urinarias 1%, sospecha de chikunguya 1,5%, adenitis mesentérica 0,5%, abdomen agudo quirúrgico 0,5%. Conclusión: Se identificó diagnósticos diferentes a la primera consulta en pacientes que recibieron ondansetrón como tratamiento sintomático de los vómitos en urgencias pediátricas, requiriendo hospitalización el 35% de los mismos.

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Section: Discussionunclassified

Diagnósticos retrasados y administración de ondansetron en el tratamiento de los vómitos en urgencias pediátricas

Cabral,

Pavlicich,

Godoy Sánchez

et al. 2024

Pediatr (Asunción).

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“… 1 Undertreatment of AGE can lead to emergency department presentation and overall higher utilisation of medical resources and costs to families. 2 Preliminary data at our clinic revealed that general paediatricians prescribed ondansetron in 1.5% of eligible patients with AGE from January 2016 to July 2018. Additionally, most patients received non-specific free-texted or prepopulated after-visit rehydration instructions that lacked key details such as fluid amounts, appropriate options for rehydration solutions, or timing of rehydration.…”

Section: Problemmentioning

confidence: 95%

“… 1 Previous studies conducted in emergency departments show improved outcomes in line with our aims of ondansetron use. Retrospective studies in paediatric patients with AGE found a decrease in return visits and shorter length of visit 2 12 associated with increased ondansetron use. A recent meta-analysis further supports the use of ondansetron in paediatric AGE, reinforcing ondansetron’s benefits of decreasing use of intravenous rehydration, duration of nausea/emesis, and need for hospitalisation.…”

Section: Introductionmentioning

confidence: 99%

Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis

et al. 2022

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In paediatric patients with acute gastroenteritis (AGE), ondansetron use decreases the need for intravenous fluids, reduces hospitalisations and shortens illness duration. Oral rehydration is also known to have excellent outcomes for mild to moderate dehydration secondary to AGE. Although these interventions are recommended in guidelines from international professional societies, baseline data at our clinic showed that <2% of these patients were offered ondansetron, and that few patients received appropriately detailed rehydration instructions. Therefore, we engaged residents and fellows as teachers and leaders in our university clinic’s quality improvement programme to promote evidence-based practice for paediatric AGE. Our gap analysis identified opportunities for interventions including educating paediatricians and paediatrics residents on the safety and utility of the medication. We created standardised oral rehydration after-visit instructions and implemented a trainee-led educational approach that encouraged appropriate medication use. We used a follow-up survey to uncover provider concerns and tailor future interventions. The process metrics included: proportion of paediatric patients appropriately treated with ondansetron (goal of 80%), and proportion of patients given appropriate oral rehydration instructions. The outcome metric was 7-day representation rates. To achieve sustainability, we restructured our process to have senior residents take ownership of teaching and data collection. Trainee-driven interventions increased ondansetron prescription rates to a median of 66.6%. Patients prescribed ondansetron were less likely to represent to care, although representation rate was low overall. Postintervention data suggests that prescription rates decreased without continued interventions and additional systems redesign may help sustain impact.

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“…Guidelines support use of Ondansetron, a 5HT3 serotonin antagonist, to improve oral tolerance. Ondansetron, a highly safe and efficacious therapy, has been increasing in usage in the United States (21) but classically is used at relatively low rates (22), possibly secondary to reports of long Q wave and T wave (QT) induced by 32-64 mg IV doses used in chemotherapy patients. This effect has been interrogated multiple times in pediatrics, demonstrating either a very low or no effect of QT prolongation at typical dosages of 2-8 mg dosage in otherwise healthy children (23,24).…”

Section: Current Guidelines For and Advances In The Management Of Acu...mentioning

confidence: 99%

The Cutting Edge of Gastroenteritis

Arostegui

Wallach

2021

J. pediatr. gastroenterol. nutr.

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In recent years, multiple advances have been made in the care, diagnosis, and mechanistic understanding of acute gastroenteritis (AGE). In this review, we discuss the current state of the art of diagnosis and management, as well as how changes in practice can improve care and decrease costs. We will discuss present study demonstrating the effect of AGE on the microbiome and how that may be linked to secondary effects or long-term changes. We will explore the use of novel technologies to further our capacity to understand how gastrointestinal infections occur and promulgate. Finally, will discuss advances in our understanding of how gastrointestinal infections capacitate other changes such as post-viral motility or other post viral intestinal dysfunction.

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Ondansetron Prescription Is Associated With Reduced Return Visits to the Pediatric Emergency Department for Children With Gastroenteritis

Cited by 6 publications

References 16 publications

Diagnósticos retrasados y administración de ondansetron en el tratamiento de los vómitos en urgencias pediátricas

Diagnósticos retrasados y administración de ondansetron en el tratamiento de los vómitos en urgencias pediátricas

Improving ondansetron use and oral rehydration instructions for pediatric acute gastroenteritis

The Cutting Edge of Gastroenteritis

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