Oral versus intravenous: rehydration preferences of pediatric emergency medicine fellowship directors.
OBJECTIVE
The American Academy of Pediatrics (AAP) recommends oral rehydration therapy (ORT) for management of uncomplicated childhood gastroenteritis with mild-moderate dehydration. However, ORT is widely underused relative to their recommendations. We compared ORT use by directors of Pediatric Emergency Medicine (PEM) fellowship training programs with AAP recommendations, and sought to identify their barriers to ORT.


METHODS
Mail/fax survey of the directors of U.S. and Canadian PEM fellowship programs. The survey included 10 scenarios of mild or moderately dehydrated children with gastroenteritis, a personal innovativeness scale, self-assessment of ORT experience and knowledge, and open-ended questions regarding perceived barriers to ORT use.


RESULTS
60/67 (89.6%) PEM fellowship program directors responded. All reported experience with and knowledge about ORT. Only 10/58 (17.2%) believe ORT is usually better than intravenous (i.v.) rehydration in all 10 clinical scenarios, and only 4/58 (6.7%) usually use ORT in all 10 scenarios. 18/58 (31%) usually use ORT for all mildly but no moderately dehydrated children. ORT use did not correlate with personal innovativeness scores. Important barriers cited by respondents include additional time requirements for ORT relative to i.v. rehydration (76.7%) and expectation of i.v. rehydration by parents (41.7%) or primary care physicians (10%).


CONCLUSIONS
Relative to AAP recommendations, PEM fellowship directors underuse ORT, especially for moderately dehydrated children. Physician innovativeness does not influence ORT use. Further study of effectiveness, length of stay, staff requirements, and ORT acceptance in the emergency department setting, especially in children with moderate dehydration, may influence ORT use.
Conners
G P
GP
Department of Emergency Medicine, University of Rochester Medical Center, New York 14642, USA. gregory_conners@urmc.rochester.edu
Barker
W H
WH
Mushlin
A I
AI
Goepp
J G
JG
D001291:Attitude of Health Personnel; D002170:Canada; D002755:Choice Behavior; D003681:Dehydration / Q000209:etiology / Q000628:therapy*; D004635:Emergency Medicine / Q000193:education / Q000379:methods* / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods* / Q000706:statistics & numerical data; D005257:Fellowships and Scholarships; D005440:Fluid Therapy / Q000379:methods* / Q000706:statistics & numerical data; D005759:Gastroenteritis / Q000150:complications; D019983:Guideline Adherence / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods* / Q000706:statistics & numerical data; D010372:Pediatrics / Q000193:education / Q000379:methods* / Q000706:statistics & numerical data; D008486:Physician Executives / Q000193:education / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States