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Outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration

BACKGROUND: Gastroenteritis is one of the most common diseases that affects children and remains a leading cause of morbidity and mortality around the world. There is conflicting evidence regarding the effect of rapid intravenous fluid regimen on the clinical outcome of patients with acute gastroent...

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Autores principales: Almutairi, Mohammed Khalaf, Al-Saleh, Abdullah M., Al Qadrah, Bedoor H., Sarhan, Nora Tarig, Alshehri, Norah Abdullah, Shaheen, Naila A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: King Faisal Specialist Hospital and Research Centre 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9072229/
https://www.ncbi.nlm.nih.gov/pubmed/35573064
http://dx.doi.org/10.1016/j.ijpam.2021.03.003
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author Almutairi, Mohammed Khalaf
Al-Saleh, Abdullah M.
Al Qadrah, Bedoor H.
Sarhan, Nora Tarig
Alshehri, Norah Abdullah
Shaheen, Naila A.
author_facet Almutairi, Mohammed Khalaf
Al-Saleh, Abdullah M.
Al Qadrah, Bedoor H.
Sarhan, Nora Tarig
Alshehri, Norah Abdullah
Shaheen, Naila A.
author_sort Almutairi, Mohammed Khalaf
collection PubMed
description BACKGROUND: Gastroenteritis is one of the most common diseases that affects children and remains a leading cause of morbidity and mortality around the world. There is conflicting evidence regarding the effect of rapid intravenous fluid regimen on the clinical outcome of patients with acute gastroenteritis. This study aimed to assess the current practice of intravenous hydration on the clinical outcomes of pediatric patients with acute gastroenteritis and determine the predictive factors for early discharge and emergency department (ED) revisit. METHODS: A cohort study was carried out among children aged from 1 month to 14 years who presented to the ED in a tertiary care hospital between September 2015 and September 2017. Children diagnosed with acute gastroenteritis and moderate dehydration who require intravenous hydration were included in the study. The patients were followed up until discharge from ED, admission to the hospital or revisit to the ED. Collected variables were demographics, presenting symptoms, biochemical marker, amount of intravenous fluid (IVF) received and prescription of anti-emetics. Descriptive statistics were summarized as mean, standard deviation for continuous variables and proportions for categorical variables. Logistic regression was used to identify risk factors. RESULTS: Out of 284 patients, 148 (52%) were males, 20 (7%) were infants, 80 (28%) were toddlers, 90 (32%) were in preschool, 88 (31%) were in school and 6 (2.1%) were adolescents. No significant difference was observed in the admission rate, discharge within 12 h or less and ED revisits for those who received IVF ≥40 ml/kg as compared to those who received <40 ml/kg. Patients with bicarbonate level closer to normal are more likely to be discharged after 4 h (odds ratio (OR) 1.2 and 95% CI 1.12–1.43). Patients presenting only with vomiting/diarrhoea were less likely to revisit ED (OR 0.33 (95% CI 0.143 - 0.776), while patients with an increase in CO(2) level (OR 1.19 and 95% CI 1.0 -1.436) and anion gap (OR 1.29 and 95% CI 1.08–1.54) were more likely to revisit within 1 week post discharge. CONCLUSION: This study did not show any additional benefits of receiving IVF ≥ 40 ml/kg over 4 h neither in early discharge nor in reducing the ED revisit. CO(2) closer to normal was a significant predictor for early discharge in 4 h where the closer level of CO(2) and AGAP were associated with an increase in the chance of a revisit to the ED within 1 week after discharge.
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spelling pubmed-90722292022-05-13 Outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration Almutairi, Mohammed Khalaf Al-Saleh, Abdullah M. Al Qadrah, Bedoor H. Sarhan, Nora Tarig Alshehri, Norah Abdullah Shaheen, Naila A. Int J Pediatr Adolesc Med Original Article BACKGROUND: Gastroenteritis is one of the most common diseases that affects children and remains a leading cause of morbidity and mortality around the world. There is conflicting evidence regarding the effect of rapid intravenous fluid regimen on the clinical outcome of patients with acute gastroenteritis. This study aimed to assess the current practice of intravenous hydration on the clinical outcomes of pediatric patients with acute gastroenteritis and determine the predictive factors for early discharge and emergency department (ED) revisit. METHODS: A cohort study was carried out among children aged from 1 month to 14 years who presented to the ED in a tertiary care hospital between September 2015 and September 2017. Children diagnosed with acute gastroenteritis and moderate dehydration who require intravenous hydration were included in the study. The patients were followed up until discharge from ED, admission to the hospital or revisit to the ED. Collected variables were demographics, presenting symptoms, biochemical marker, amount of intravenous fluid (IVF) received and prescription of anti-emetics. Descriptive statistics were summarized as mean, standard deviation for continuous variables and proportions for categorical variables. Logistic regression was used to identify risk factors. RESULTS: Out of 284 patients, 148 (52%) were males, 20 (7%) were infants, 80 (28%) were toddlers, 90 (32%) were in preschool, 88 (31%) were in school and 6 (2.1%) were adolescents. No significant difference was observed in the admission rate, discharge within 12 h or less and ED revisits for those who received IVF ≥40 ml/kg as compared to those who received <40 ml/kg. Patients with bicarbonate level closer to normal are more likely to be discharged after 4 h (odds ratio (OR) 1.2 and 95% CI 1.12–1.43). Patients presenting only with vomiting/diarrhoea were less likely to revisit ED (OR 0.33 (95% CI 0.143 - 0.776), while patients with an increase in CO(2) level (OR 1.19 and 95% CI 1.0 -1.436) and anion gap (OR 1.29 and 95% CI 1.08–1.54) were more likely to revisit within 1 week post discharge. CONCLUSION: This study did not show any additional benefits of receiving IVF ≥ 40 ml/kg over 4 h neither in early discharge nor in reducing the ED revisit. CO(2) closer to normal was a significant predictor for early discharge in 4 h where the closer level of CO(2) and AGAP were associated with an increase in the chance of a revisit to the ED within 1 week after discharge. King Faisal Specialist Hospital and Research Centre 2022-03 2021-03-11 /pmc/articles/PMC9072229/ /pubmed/35573064 http://dx.doi.org/10.1016/j.ijpam.2021.03.003 Text en © 2021 Publishing services provided by Elsevier B.V. on behalf of King Faisal Specialist Hospital & Research Centre (General Organization), Saudi Arabia. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Almutairi, Mohammed Khalaf
Al-Saleh, Abdullah M.
Al Qadrah, Bedoor H.
Sarhan, Nora Tarig
Alshehri, Norah Abdullah
Shaheen, Naila A.
Outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration
title Outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration
title_full Outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration
title_fullStr Outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration
title_full_unstemmed Outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration
title_short Outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration
title_sort outcomes and predictors of early emergency department discharge among children with acute gastroenteritis and moderate dehydration
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9072229/
https://www.ncbi.nlm.nih.gov/pubmed/35573064
http://dx.doi.org/10.1016/j.ijpam.2021.03.003
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