Referral rates for children with acute gastroenteritis: a retrospective cohort study

Wolters, Pien I; Holtman, Gea A; Fickweiler, Freek; Bonvanie, Irma J.; Weghorst, Anouk Ah; Post, Johan; Kollen, Boudewijn J.; Berger, Marjolein Y.

doi:10.3399/bjgpopen20x101053

Cited by 4 publications

(6 citation statements)

References 12 publications

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“…Paediatrician referrals were made for 19% of children in the present study, far higher than the previously reported rate of 8%, 26 but these almost certainly resulted from the deliberate inclusion of children at increased risk of dehydration; supporting this, the degree of dehydration is known to be among the main reasons for referral and hospitalisation. 27 …”

Section: Discussioncontrasting

confidence: 45%

Cost-effectiveness of oral ondansetron for children with acute gastroenteritis in primary care: a randomised controlled trial

et al. 2021

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Background: Acute gastroenteritis is a common childhood disease with substantial medical and indirect costs, mostly because of referral, hospitalization and parental absence from work. Aim: To determine the cost-effectiveness of adding oral ondansetron to care-as-usual for children with acute gastroenteritis in out-of-hours primary care. Design and setting: A pragmatic randomised controlled trial at three out-of-hours primary care centres, with a follow-up of 7 days. Method: Inclusion criteria were: 1) age 6 months to 6 years; 2) diagnosis of acute gastroenteritis; 3) at least four reported episodes of vomiting 24 hours before presentation, whereof; 4) at least one in the 4 hours before presentation; and 5) written informed consent from both parents. Children were randomly allocated in a 1:1 ratio to either care-as-usual (oral rehydration therapy) or care-as-usual plus one dose of 0.1 mg/kg oral ondansetron. Results: In total, 194 children were included for randomisation. One dose of oral ondansetron decreased the proportion of children who continued vomiting within the first 4 hours from 42.9% to 19.5%, with an odds ratio of 0.4 (95% CI = 0.2–0.7, NNT 4). Total mean costs in the ondansetron group were 31.2% lower (€488 vs €709), and the total incremental mean costs for an additional child free of vomiting in the first 4 hours was −€9 (95% confidence interval, −€41 to €3). Conclusion: A single oral dose of ondansetron for children with acute gastroenteritis, given in out-of-hours primary care settings, is both clinically beneficial and cost-effective.

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Section: Discussioncontrasting

confidence: 45%

Cost-effectiveness of oral ondansetron for children with acute gastroenteritis in primary care: a randomised controlled trial

et al. 2021

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“…In the Askøy outbreak, one infant died with C. jejuni -gastroenteritis as a contributing cause of death. Young children are often brought to OOH services with gastroenteritis [ 21 ], and our findings reveal a significant rise in primary care contacts for young children during this outbreak, particularly in those under five years old.…”

Section: Discussionmentioning

confidence: 84%

The impact on primary care of a large waterborne campylobacter outbreak in Norway: a controlled observational study

Iversen,

Rortveit,

Wensaas

et al. 2024

Scandinavian Journal of Primary Health Care

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Objective Document the impact of an outbreak of gastroenteritis on local primary health care services, compared to a control period. Design Controlled observational study with data from the outbreak and a control period. Data obtained from electronic medical records (EMR) of general practitioners (GPs) and the out-of-hours (OOH) service. Telephone data from the OOH service’s telephone records. Setting Campylobacteriosis outbreak in Askøy municipality, Norway in 2019. Over 2000 individuals were infected. Subjects Patients in contact with GPs and the OOH service during the outbreak and a control period. Main outcome measures Patient contacts with GPs and the OOH service during the outbreak and a control period. Results There was a 36% increase in contacts during the outbreak compared to the control period (4798 vs. 3528), with the OOH service handling 78% of outbreak-related contacts. Telephone advice was the dominant method for managing the increase in contacts to primary care, both in OOH services and daytime general practice (OR 3.73 CI: [3.24–4.28]). Children aged 0–4 years had increased use of primary care during the outbreak (OR 1.51 CI: [1.28–1.78]). GPs referred 25% and OOH services referred 75% of 70 hospitalized cases. Conclusion The OOH service handled most of the patients during the outbreak, with support from daytime general practice. The outbreak caused a shift towards telephone advice as a means of providing care. Young children significantly increased their use of primary care during the outbreak.

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“…Overall, ORT intake was low (10 ml/4 hours) and referral rates were high (19% in comparison with a mean referral rate of 8.1%). 3 Ondansetron use did not appear to increase ORT intake or lead to fewer hospital referrals or admissions; nevertheless, parents were more satisfied with the addition of ondansetron compared with ORT alone.…”

Section: Discussionmentioning

confidence: 86%

“…About 5% of all general practitioner (GP) consultations with children in the Netherlands are for AGE (2). Among those seen in primary care, 8.1% are referred to specialist care and 8000 are admitted to the hospital each year (2,3). However, it is thought that many of these referrals and admissions can be avoided (4).…”

Section: Introductionmentioning

confidence: 99%

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Oral ondansetron for paediatric gastroenteritis in primary care: a randomised controlled trial

et al. 2021

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Background: Acute gastroenteritis affects almost all children younger than 5 years. Due to vomiting the standard oral rehydration therapy (ORT) treatment is less effective. In secondary care, ondansetron was found to be effective in reducing vomiting. Aim: To determine the effectiveness of adding oral ondansetron to care-as-usual on vomiting in children with acute gastroenteritis attending out-of-hours primary care. Design and setting: A pragmatic randomised controlled trial with a follow-up of 7 days, at three out-of-hours primary care centres. Method: Inclusion criteria: 1) age 6 months to 6 years, 2) acute gastroenteritis diagnosed by a general practitioner, 3) at least four reported episodes of vomiting in the 24 hours before presentation, 4) at least one reported episode of vomiting in the 4 hours before presentation, and 5) written informed consent from both parents. The control group received care-as-usual (ORT). The intervention group received care-as-usual plus one dose of oral ondansetron (0.1 mg/kg). Results: In total, 194 children were included for randomisation. One dose of oral ondansetron decreased the proportion of children who continued vomiting within 4 hours from 42.9% to 19.5%, with an odds ratio of 0.37 (95% CI = 0.20–0.72, NNT 4). Ondansetron also decreased the number of vomiting episodes within 4 hours, incidence rate ratio of 0.51 (95% CI, 0.29-0.88), and improved overall parental satisfaction with treatment (p = 0.027). Conclusions: Ondansetron decreased vomiting and increased parental satisfaction in children with acute gastroenteritis. We were not able to show an increased ORT intake or decrease in referral rate.

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Referral rates for children with acute gastroenteritis: a retrospective cohort study

Cited by 4 publications

References 12 publications

Cost-effectiveness of oral ondansetron for children with acute gastroenteritis in primary care: a randomised controlled trial

Cost-effectiveness of oral ondansetron for children with acute gastroenteritis in primary care: a randomised controlled trial

The impact on primary care of a large waterborne campylobacter outbreak in Norway: a controlled observational study

Oral ondansetron for paediatric gastroenteritis in primary care: a randomised controlled trial

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