Successful Discharge of Children with Gastroenteritis Requiring Intravenous Rehydration

• Published in: The Journal of emergency medicine Vol. 46; no. 1; pp. 9 - 20
• Main Authors: Freedman, Stephen B., MDCM, MSC, FRCPC, FAAP, DeGroot, Julie M., MSC, Parkin, Patricia C., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2014
• Subjects: acidosis; Administration, Intravenous; ambulatory care facilities; Antiemetics - therapeutic use; Bicarbonates - blood; Biomarkers - blood; Child; Child, Preschool; Dehydration - blood; Dehydration - etiology; Dehydration - therapy; emergencies; Emergency; Emergency Service, Hospital; Fluid Therapy; gastroenteritis; Gastroenteritis - complications; Humans; Infant; intravenous infusions; Ondansetron - therapeutic use; Patient Discharge; Predictive Value of Tests; Primary Health Care; Recurrence; Severity of Illness Index; intravenous infusions; ambulatory care facilities; emergencies; gastroenteritis; acidosis
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2013.04.044

Abstract Background Emergency Department (ED) revisits are very common in children with gastroenteritis administered intravenous rehydration. Study Objectives To determine if bicarbonate values are associated with ED revisits in children with gastroenteritis. Methods We conducted a secondary analysis of prospectively collected data, which included children >3 months of age with gastroenteritis treated with intravenous rehydration. Regression analysis was employed to determine whether, among discharged children, bicarbonate independently predicts revisits within 7 days (primary outcome) and successful discharge (secondary outcome). The latter composite outcome measure was defined as discharge at the index visit and the absence of a revisit requiring intravenous rehydration. Results Of 226 potentially eligible children, 174 were discharged and were included in the primary outcome analysis. Of the eligible children, 18% (30/174) had a revisit that was predicted by a higher baseline bicarbonate (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.0–1.3; p = 0.03), absence of a primary care provider (OR 7.8; 95% CI 1.2–51.0; p = 0.03), and ondansetron administration (OR 2.4; 95% CI 1.0–5.5; p = 0.05). Bicarbonate was not associated with successful discharge. Negatively associated independent predictors of successful discharge were volume of intravenous fluids administered (OR 0.84/10 mL/kg increase; 95% CI 0.76–0.93; p < 0.001), and baseline clinical dehydration score (OR 0.75/unit increase; 95% CI 0.58–0.97; p < 0.001). Revisits requiring intravenous rehydration and hospitalization were associated with higher bicarbonate values (21.2 ± 4.6 mEq, p = 0.001, and 22.3 ± 5.0 mEq/L, p < 0.001, respectively). Conclusion Lower serum bicarbonate values at the time of intravenous rehydration are not associated with unfavorable outcomes after discharge.