Emergency department management of gastro-enteritis in Australia and New Zealand.
OBJECTIVE
Comparison of clinical practice guideline (CPG) recommendations and reported physician management of gastro-enteritis at Paediatric Research in Emergency Departments International Collaborative (PREDICT) network sites as a baseline for further randomised controlled trials.


METHODS
Two part survey comprising: (i) review of CPGs from PREDICT sites for gastro-enteritis; and (ii) survey of senior emergency department physicians regarding the management of gastro-enteritis.


RESULTS
All 11 PREDICT sites participated. Nine CPGs were available with three sites using a common CPG. For moderate dehydration, eight CPGs advocated nasogastric (NG) rehydration in preference to intravenous (IV) rehydration. The IV route was reserved for severe dehydration or failed NG rehydration. In the second component of the survey, 78 of 83 (94%) physicians responded. In moderate dehydration, 82% of respondents used NG rehydration. In severe dehydration, 86% used IV fluids; 12% used NG and 3% an initial IV bolus followed by NG fluid. Serum electrolytes were measured universally with IV fluid use and by 22% using NG rehydration. The IV fluid bolus was with normal saline (86%). Fifty-four per cent used anti-emetics 'rarely' or 'sometimes'. The commonest agents were ondansetron (60%) and metoclopramide (29%).


CONCLUSIONS
CPG recommendations and physician practice for the management of gastro-enteritis were similar across PREDICT sites with a focus on NG for moderate dehydration and IV for severe dehydration. A variety of fluids and administration rates were used. Anti-emetics were used infrequently. The efficacy and safety of newer anti-emetics should be explored in collaborative studies. Collaborative development of new CPGs should be considered to simplify fluid regimens.
Emergency Department, Womens and Childrens Hospital, Adelaide, South Australia, Australia. jacquie.schutz@cywhs.sa.gov.au
Jacquie
J
Schutz
Franz E
FE
Babl
Nisa
N
Sheriff
Meredith
M
Borland
D000208:Acute Disease; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use; D001315:Australia; D003625:Data Collection; D003681:Dehydration / Q000145:classification / Q000628:therapy; D003967:Diarrhea / Q000188:drug therapy; D004635:Emergency Medicine / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005759:Gastroenteritis / Q000628:therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage / Q000627:therapeutic use; D009520:New Zealand; D017294:Ondansetron / Q000008:administration & dosage / Q000627:therapeutic use; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000188:drug therapy
D000932:Antiemetics; D017294:Ondansetron; D008787:Metoclopramide