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About Sickkids
About SickKids

January 28, 2011

Treatment of vomiting and diarrhea in emergency departments varies across the country

In Canada, it is estimated that 239,000 children visit the emergency department every year with vomiting or diarrhea due to an intestinal infection commonly called gastroenteritis.  If the vomiting or diarrhea is significant enough, children may develop dehydration.  Although the vast majority of children develop only minimal dehydration, in severe cases they may require intravenous treatment and even hospitalization.  A multicentre study led by The Hospital for Sick Children (SickKids) evaluated the treatment of paediatric gastroenteritis in Canadian emergency departments and found that clinical practices varied dramatically. While guidelines describe the need to use oral rehydration therapy in all but severe cases, intravenous rehydration is often employed to treat children with lesser degrees of dehydration.  The study was published in an advance online edition of Pediatrics on Jan. 24, 2011.  

In 2006, Dr. Stephen Freedman, lead author for this study and Physician in the SickKids Departments of Paediatric Emergency Medicine and Gastroenterology, Hepatology and Nutrition, released a study that showed the use of an anti-vomiting drug called ondansetron in addition to oral rehydration therapy reduces vomiting and the need for intravenous rehydration.  Moreover, in October 2010 he found that the appropriate use of ondansetron to prevent the need for intravenous rehydration results in both clinical and economic benefits, annually saving Canadian society an average of $1.72 million. The next logical step was to assess what rehydration therapies are being used by health-care institutions, and to attempt to understand the overuse of intravenous rehydration by Canadian emergency physicians, explains Freedman who is also Associate Scientist at SickKids and Assistant Professor of Paediatrics at the University of Toronto.  

This nationwide study focused on children aged three to 48 months in 11 emergency departments and found that 23 per cent of patients suffering from gastroenteritis received intravenous rehydration.  More importantly, there was enormous variation between centres in the use of intravenous rehydration, with the most significant predictor of intravenous usage being the emergency department where care was provided.  In addition, “patients who received intravenous rehydration at the initial emergency visit were twice as likely to revisit the hospital,” says Freedman who postulates that the use of intravenous rehydration “may have an effect on the caregiver, making the diagnosis seem more severe, and causing the caregiver to believe that another trip to the hospital is necessary.”

According to Freedman, there is a variation in treatment across the country because there is a gap between evidence-based guidelines and clinical practice. Knowledge translation is needed in order to close the gap and enhance rehydration practices.

“Evidence shows that oral rehydration therapy is both clinically and economically advantageous, and should be the standard of care for the vast majority of children with gastroenteritis,” says Freedman.  He also explains that continued research into the association between intravenous rehydration and consequent health-care use is warranted.