Parental Preference for Rehydration Method for Children in the Emergency Department

Karpas, Anna; Finkelstein, Marsha; Reid, Samuel

doi:10.1097/pec.0b013e3181a34144

Cited by 34 publications

(33 citation statements)

References 18 publications

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“…However, less within-country variability in the type of IV or NG rehydration was observed, suggesting an influence of training and health care organization, specific to each country, on physician practices [9]. Hoekstra in Australia and New-Zealand [11], and Karpas in Canada [12], have also shown differences in practice after ORS failure in different hospitals within the same country.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, a real risk/benefit assessment of the widespread use of ondansetron in AGE in Europe is still lacking. Studies have shown that parents prefer IV rehydration [12] and treatments that shorten diarrhea duration [15]. With respect to health care providers, another recent study indicated that only 14% of physicians favor NG over IV rehydration [16].…”

Section: Discussionmentioning

confidence: 99%

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Pediatric gastroenteritis in the emergency department: practice evaluation in Belgium, France, The Netherlands and Switzerland

et al. 2014

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BackgroundBased on European recommendations of ESPGHAN/ESPID from 2008, first line therapy for dehydration caused by acute gastroenteritis (AGE) is oral rehydration solution (ORS). In case of oral route failure, nasogastric tube enteral rehydration is as efficient as intra-venous rehydration and seems to lead to fewer adverse events. The primary objective was to describe rehydration strategies used in cases of AGE in pediatric emergency departments (PEDs) in Belgium, France, The Netherlands, and Switzerland.MethodsAn electronic survey describing a scenario in which a toddler had moderate dehydration caused by AGE was sent to physicians working in pediatric emergency departments. Analytical data were analyzed with descriptive statistics and Kruskal –Wallis Rank test.ResultsWe analyzed 68 responses, distributed as follows: Belgium N = 10, France N = 37, The Netherlands N = 7, and Switzerland N = 14. Oral rehydration with ORS was the first line of treatment for 90% of the respondents. In case of first line treatment failure, intravenous rehydration was preferred by 95% of respondents from France, whereas nasogastric route was more likely to be used by those from Belgium (80%), The Netherlands (100%) and Switzerland (86%). Serum electrolyte measurements were more frequently prescribed in France (92%) and Belgium (80%) than in The Netherlands (43%) and Switzerland (29%). Racecadotril was more frequently used in France, and ondansetron was more frequently used in Switzerland. No respondent suggested routine use of antibiotics.ConclusionWe found variations in practices in terms of invasiveness and testing. Our study supports the need for further evaluation and implementation strategies of ESPGHAN/ESPID guidelines. We plan to extend the study throughout Europe with support of the Young ESPID Group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pediatric gastroenteritis in the emergency department: practice evaluation in Belgium, France, The Netherlands and Switzerland

et al. 2014

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“…However, physicians have often resisted administering ORT, believing it to be time-consuming and a drain on clinical resources [37]. One study surveyed parents who were educated on oral versus intravenous rehydration and found that nearly twice as many parents chose the intravenous method when given a choice [38 ]. Following treatment, however, another study showed that parents' satisfaction is much greater with oral versus intravenous rehydration [39].…”

Section: Enteral Versus Parenteral Fluid Resuscitationmentioning

confidence: 97%

Pediatric rapid fluid resuscitation

Simpson

Teach

2011

Current Opinion in Pediatrics

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Rapid fluid resuscitation is most commonly used for children with moderate-to-severe dehydration, or for patients in shock to restore circulation. Concerns regarding potential for fluid overload and electrolyte disturbances and regarding the method of rehydration (i.e., enteral versus parenteral) raise some debate about the safety and efficacy of rapid fluid resuscitation in the pediatric patient. Recent studies show that early, aggressive fluid resuscitation of up to 60 ml/kg within 1-2 h may be necessary to replenish circulating intravascular fluid volume. Complications of severe electrolyte disturbances, cerebral edema, or uncontrolled hemorrhage are uncommon and can often be avoided with early clinical assessment and reassessments throughout the resuscitation. In the mildly to moderately dehydrated child, enteral fluid resuscitation with the aid of an antiemetic such as ondansetron can be as effective and efficient as intravenous fluid resuscitation.

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“…The latter is significant because, when given the opportunity to decide, 62% of caregivers chose intravenous rehydration over ORT. 30 However, the availability of an effective, orally administered antiemetic might make them choose ORT instead. 30 Dehydration has been identified as the most common diagnosis resulting in ED revisits, as well as revisits requiring hospitalization.…”

Section: Figurementioning

confidence: 99%

“…30 However, the availability of an effective, orally administered antiemetic might make them choose ORT instead. 30 Dehydration has been identified as the most common diagnosis resulting in ED revisits, as well as revisits requiring hospitalization. 31 However, this fact is underrecognized by health care providers.…”

Section: Figurementioning

confidence: 99%

Prospective Assessment of Practice Pattern Variations in the Treatment of Pediatric Gastroenteritis

et al. 2011

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Parental Preference for Rehydration Method for Children in the Emergency Department

Abstract: When given the opportunity to make an informed decision, more parents chose intravenous rehydration. However, the prospect of an effective oral antiemetic medication might lead more parents to choose oral rehydration.

Cited by 34 publications

References 18 publications

Pediatric gastroenteritis in the emergency department: practice evaluation in Belgium, France, The Netherlands and Switzerland

Pediatric gastroenteritis in the emergency department: practice evaluation in Belgium, France, The Netherlands and Switzerland

Pediatric rapid fluid resuscitation

Prospective Assessment of Practice Pattern Variations in the Treatment of Pediatric Gastroenteritis

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