Scribd Logo
Upload

Welcome to Scribd!

  • A Randomized Trial of Oral Vs Intravenous Rehydration in A Pediatric Emergency Departement

    Uploaded by

    Untuk Download
    9 views4 pages

    Original Title

    A Randomized Trial of Oral vs Intravenous Rehydration in a Pediatric Emergency Departement

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    9 views4 pages

    A Randomized Trial of Oral Vs Intravenous Rehydration in A Pediatric Emergency Departement

    Uploaded by

    Untuk Download

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    of 4
    porate A Randomized Trial of Oral vs Intravenous Rehydration in a Pediatric Emergency Department Ywonne C. Atherly-John, MD; Sandra J. Cunningham, MD; Ellen P. Crain, MD, PhD Background: Physicians report several barriers to the use of oral rehydration therapy (ORT) for debydration in children due to acute gastroenteritis. Objectives: To compare ORT with intravenous therapy for the treatment of moderate dehydration in children with acute gastroenteritis and to determine whether the factors reported as barriers to the use of ORT would be substantiated in practice. Methods: Randomized controlled trial in an urban ped alric emergency department. Children with moderate de hydration due to acute gastroenteritis were randomly as- signed to ORT (group 1) oF intravenous therapy (group 2). The primary outcome was length of stay in the emer- ‘gency department, Secondary outcomes included hospi- tal admission rate, stalf time, relapse after discharge from the hospital, and parental satisfaction. Two days after dis- ‘charge, parents were surveyed by telephone to assess the relapse and their satisfaction with the visit. Results: Eighteen patients were enrolled in group 1 and 16 in group 2. The mean length of stay in group 1 was 225 vs 358 minutes in group 2 (P<01). Mean staff ime ‘Was 35.8 minutes in group 1 compared with 65 minutes in group 2 (P=.03). Three patients failed ORT and re- quired intravenous therapy. Two patients (11%) in group ys 4 (25 %) in group 2 required admission to the hos- pital (P=.20). No patients relapsed after being dis- charged from the hospital. Fourteen parents (77%) in group 1 compared with 6 (37.5%) in group 2 reported that they were highly satisfied with all aspects ofthe visit (P20) Conelustons: Reported barriers to ORT were not sup- ported by ourdata, Moreover, ORT performed better than intravenous therapy on all measured outcomes, “Arch Pediatr Adolese Med. 2002;156:1240-1243 From the Department of Pediatrics, Division of Emergency Medicine, Albert Einstein Collegeof Medicine Jacobi Medical Centr, Brons, NY. N THE United States, acute gas- troenteritis (AGE) in children younger than 5 years is respon- sible for approximately 3.7 mil- lion acute care visits annually Two hundred twenty thousand children are hospitalized each year, accounting for aan estimated 925000 hospital days. For editorial comment see page 1177 The American Academy of Pediat- rics! and the Centers for Disease Controland Prevention® recommend oral rehydration therapy (ORT) for the treatment of mild or ‘moderate dehydration secondary to AGE. Data from several studies have shown that ORT isas effective as, and less costly than, Intravenous therapy (IVT)."* Despite these recommendations, recent surveys suggest that many emergency department and pr ‘mary care physicians preferentially use IVT rather than ORT for children who are de- hydrated ® Some reasons cited for this prc- Lice include the belie that ORT requires a (©2002 American Med longer duration of therapy. is ineffective in the presence of moderate dehydration, and requires additional staf time for patient care sand that parents prefer IVT.’ However, there are no published studies that evaluate the validity of the reported barriers to the use of ORT. This study compares ORT with IVT for the treatment of moderate dehydration in children with AGE and determines whether the factors reported as barriers to the use of ORT would be substantiated in practice kml — Previously healthy children aged 3 months to 17 years who presented to a pediatric emer- gency department (PED) in an urban public Hospital with signs and symptoms of AGE for lessthan 1 week, in association with dehydra- tion, were serenedforeligibility Children who ret atleast 4 standard published criteria for toderate dehydration" were eligible for en- rollment inthis study, These criteria included tachycardia, dry mucous membranes, de- pressed anterior fontanelle, sunken eyeballs, abnormal skin turgor, decreased urine out. put, absent oF minimal tears, listlessness or 1 Association, All rights reserved. drowsiness, thirst, and postural hypotension. Patents with chronic lines, severe dehydration or shock, prottacted vorn- iting, absent bowel sounds, no accompanying guardian, or no contac telephone number, and thse requlring inravenousac- ‘cessor reasons other than hydration, wer excluded. The study ‘vas spproved by the Commitee on Clnial Investigations at the Alert Einsiein College of Medicine, Bronx, NY ‘Aller parental consent, elge patents were randomly as- signed to Fecelve ORT or 1VE- Randomization as accom plished by placing odd and even numbers na sealed, opaque Eomlainer A clerial staff member drew number tht wae then signed tothe child. Children sesigned even numbers under- ‘vent treatment with ORT; children given odd numbers under- ‘vent treatment with IVT, Children assigned to the IVT group Teerived an inital bol of 0 mL/kg of a isotonic sodium chlo fide solution over a 30-minute period. A second bolus of an ttotone sodium chloride solution was administered if neces sary, as determined bythe treating physician. This was fl- towed by an intravenots slution of 9% dextrose in 09% sa line in children 2 years and older, and 3% dextrose in 0.33% saline in children younger than 2 years. The dextrose-salineso- iain was administered ata rate of is limes dally mainte tance, Commercially prepared oral maintenance electolytes0- Tutons were ntrdiced during maintenance therapy. arate of Sm or 10 ml. every 5 minutes, depending on the age ofthe ‘hid Children assigned to the ORT group reeled commer- lally prepared oral maintenance electolye solutions ata rate ofS every minutes they were younger than 4 years, and Tom. every minutes hey were years or olde. the child did not vomit during the fist out of ORT, intake was d= ‘anced twice the ital volume and given every 3 minutes ‘ral aide were withheld for 30 minutes ithe patent vor ited, and then were restated athe inal rate Oral Mud were ‘Aiministered bya paren or guardian, Patients who vomited for more imes ae the ination of ral therapy were consid- red tohave failed ORT and IVT was stared. Because this as Sn inention-t-teat study, these patients remained inthe ORT ir0up for data analyst al patents were evaluated at 30-to 60-minute intervals stool cultures and serum chemistry studies were obtained at the discretion of the treating atending physician, The dec son to discharge the patient from the PED was made by the tending physician when the patents presenting signs and symptoms of dehydration were revered and vomiting had eased. Patients who continued to vomit despte IVT and with- Holding of oral Nude were hospitalized “The primary outcome measure was duration of PED say, defined at time fom enrollment to final disposition. Second Sty outcomes incinded staf time equired fr patent car, hos pill admission rate, rlape llr being discharged from the hos Pla and parental atistcton with ae, All medical caregivers Alocumented the ume spent providing patient cae. Two to Alaysaler discharge rom the PED, an investigation, blinded o the patients treatment group assignment, surveyed parents by telephone to asseserclapse ae well arsatisaction with the visit Relapse wae determined by inquiring whether the patent re ied sdational unscheduled medical intervention forthe sme Complaint. Saisfaction was asessed using the modified Pa- tent Satisfaction Questionnaire" We estimated that 34 pa- tents were needed to detect diference of 60 mints inthe

    You might also like