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Freedman SB, Roskind CG, Schuh S, et al. Comparing Pediatric Gastroenteritis Emergency Department Care in Canada and the United States. Pediatrics. 2021;147(6)doi: 10.1542/peds.2020-030890.
Freedman, S. B., Roskind, C. G., Schuh, S., VanBuren, J. M., Norris, J. G., Tarr, P. I., Hurley, K., Levine, A. C., Rogers, A., Bhatt, S., Gouin, S., Mahajan, P., Vance, C., Powell, E. C., Farion, K. J., Sapien, R., O'Connell, K., Poonai, N., Schnadower, D. (2021). Comparing Pediatric Gastroenteritis Emergency Department Care in Canada and the United States. Pediatrics, 147(6), . https://doi.org/10.1542/peds.2020-030890
Freedman, Stephen B, et al. "Comparing Pediatric Gastroenteritis Emergency Department Care in Canada and the United States." Pediatrics vol. 147,6 (2021). doi: https://doi.org/10.1542/peds.2020-030890
Freedman SB, Roskind CG, Schuh S, VanBuren JM, Norris JG, Tarr PI, Hurley K, Levine AC, Rogers A, Bhatt S, Gouin S, Mahajan P, Vance C, Powell EC, Farion KJ, Sapien R, O'Connell K, Poonai N, Schnadower D. Comparing Pediatric Gastroenteritis Emergency Department Care in Canada and the United States. Pediatrics. 2021 Jun;147(6). doi: 10.1542/peds.2020-030890. Epub 2021 May 20. PMID: 34016656.
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Pediatrics. 2021 Jun;147(6). doi: 10.1542/peds.2020-030890. Epub 2021 May 20.

Comparing Pediatric Gastroenteritis Emergency Department Care in Canada and the United States.

Pediatrics

Stephen B Freedman, Cindy G Roskind, Suzanne Schuh, John M VanBuren, Jesse G Norris, Phillip I Tarr, Katrina Hurley, Adam C Levine, Alexander Rogers, Seema Bhatt, Serge Gouin, Prashant Mahajan, Cheryl Vance, Elizabeth C Powell, Ken J Farion, Robert Sapien, Karen O'Connell, Naveen Poonai, David Schnadower,

Affiliations

  1. Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; [email protected].
  2. Department of Emergency Medicine, Medical Center, Columbia University, New York, New York.
  3. Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario.
  4. Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah.
  5. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri.
  6. Department of Emergency Medicine, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
  7. Department of Emergency Medicine, Hasbro Children's Hospital, Rhode Island Hospital and Brown University, Providence, Rhode Island.
  8. Departments of Emergency Medicine and Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
  9. Division of Emergency Medicine, Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  10. Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada.
  11. Departments of Emergency Medicine and Pediatrics, School of Medicine, University of California, Davis, Sacramento, California.
  12. Department of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
  13. Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
  14. Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
  15. Departments of Pediatrics and Emergency Medicine, School of Medicine and Health Sciences, George Washington University and Children's National Hospital, Washington, DC; and.
  16. Departments of Paediatrics, Internal Medicine, and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada.

PMID: 34016656 DOI: 10.1542/peds.2020-030890

Abstract

BACKGROUND: Between-country variation in health care resource use and its impact on outcomes in acute care settings have been challenging to disentangle from illness severity by using administrative data.

METHODS: We conducted a preplanned analysis employing patient-level emergency department (ED) data from children enrolled in 2 previously conducted clinical trials. Participants aged 3 to <48 months with <72 hours of gastroenteritis were recruited in pediatric EDs in the United States (

RESULTS: In adjusted analysis, unscheduled revisits within 7 days did not differ (adjusted odds ratio [aOR]: 0.72; 95% confidence interval (CI): 0.50 to 1.02). At the index ED visit, although participants in Canada were assessed as being more dehydrated, intravenous fluids were administered more frequently in the United States (aOR: 4.6; 95% CI: 2.9 to 7.1). Intravenous fluid administration rates did not differ after enrollment (aOR: 1.4; 95% CI: 0.7 to 2.8; US cohort with Canadian as referent). Overall, intravenous rehydration was higher in the United States (aOR: 3.8; 95% CI: 2.5 to 5.7). Although hospitalization rates during the 7 days after enrollment (aOR: 1.1; 95% CI: 0.4 to 2.6) did not differ, hospitalization at the index visit was more common in the United States (3.9% vs 2.3%; aOR: 3.2; 95% CI: 1.6 to 6.8).

CONCLUSIONS: Among children with gastroenteritis and similar disease severity, revisit rates were similar in our 2 study cohorts, despite lower rates of intravenous rehydration and hospitalization in Canadian-based EDs.

Copyright © 2021 by the American Academy of Pediatrics.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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