Clinical pathway using rapid rehydration for children with gastroenteritis

Authors


 Dr SJ Phin, Emergency Department, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. Fax: +61 2 9845 2468; email: susanp3@chw.edu.au

Abstract

Objective:  To determine in the Emergency Department (ED) the efficacy of a clinical pathway using rapid rehydration for children moderately dehydrated as a result of acute gastroenteritis.

Methods:  This was a prospective study using historical controls, set in the ED of the Children's Hospital at Westmead, NSW, Australia. Subjects were aged from 6 months to 16 years presenting with vomiting and diarrhoea for <48 h who were mildly or moderately dehydrated. The intervention was a clinical pathway involving rapid rehydration using N/2 saline + 2.5% dextrose intravenously at 20 mL/kg per h for 2 h, or Gastrolyte R (Aventis Pharma, Lane Cove, NSW, Australia) via nasogastric tube at the same rate. There were 145 children in the prospective intervention group and 170 in the historical control group. The outcome measures were admission rate, percentage of patients discharged from the ED in 8 h or less, rate of re-presentations within 48 h requiring admission, and rate of procedures with intravenous cannula or nasogastric tube.

Results:  In the moderately dehydrated children, significant reductions were observed in the admission rate and the number discharged in 8 h or less in the intervention group compared with the control group, with no significant difference in the rate of re-presentation and the rate of procedures. In the moderately dehydrated children in the intervention group, the admission rate was 29 of 52 (55.8%) compared with the controls 26 of 27 (96.3%) (P < 0.001) and the number discharged in 8 h or less was 23 of 52 (44.2%) compared with 1 of 27 (3.7%) in the controls (P < 0.01).

Conclusion:  The clinical pathway utilizing rapid rehydration in children moderately dehydrated from gastroenteritis is effective in reducing admission rates and lengths of stay in the ED.

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