title: Health care provider and caregiver preferences regarding nasogastric and intravenous rehydration.
abstract: OBJECTIVE
  Despite evidence supporting its use, nasogastric rehydration is rarely used in North America. We conducted a prospective, cross-sectional, 3-phase study to evaluate current perspectives.
  
  
  METHODS
  We compared the proportions of respondents in favor of nasogastric (as opposed to intravenous) rehydration, should oral rehydration fail, between clinicians and caregivers. Phase 1: caregivers of children aged 3 to 48 months, who presented to a Canadian pediatric emergency department with symptoms of gastroenteritis, were invited to complete a survey. Phase 2: phase 1 participants administered intravenous or nasogastric rehydration had the procedure observed and outcome data recorded. Phase 3: pediatric emergency medicine physicians, fellows, and nurses completed a survey.
  
  
  RESULTS
  Four hundred thirty-five children-parent dyads and 113 health care providers participated. If oral rehydration were to fail, 10% (47 of 435) of caregivers and 14% (16 of 113) of clinicians would choose nasogastric rehydration (difference = 3.4%; 95% confidence interval: -2.8 to 11.4). Caregivers were more familiar with the term intravenous than nasogastric rehydration (80% vs 20%; P < .001). Sixty-four children (15%) received intravenous rehydration; none received nasogastric rehydration. Participating nurses have inserted 90 (interquartile range: 25-150) intravenous cannulas compared with 4 (interquartile range: 2-10) nasogastric tubes during the preceding 6 months (P < .001). After a brief educational intervention, the proportion recommending nasogastric rehydration increased to 27% (117 of 435) among caregivers (P < .001) and 43% (49 of 113) among health care providers (P < .001).
  
  
  CONCLUSIONS
  In keeping with caregiver desires, health care providers in a Canadian emergency department employ intravenous rehydration when oral rehydration fails. Enhanced change management strategies will be required for nasogastric rehydration to become adopted in this environment.
authors.affiliation: Divisions of aPediatric Emergency Medicine, Hospital for Sick Children Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. stephen.freedman@albertahealthservices.ca
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
authors.forename: Laura E
authors.initials: LE
authors.lastname: Keating
authors.forename: Maggie
authors.initials: M
authors.lastname: Rumatir
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuh
mesh_terms: D001291:Attitude of Health Personnel; D002675:Child, Preschool; D002755:Choice Behavior; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy / Q000379:methods* / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous / Q000523:psychology* / Q000706:statistics & numerical data; D007318:Inservice Training; D007441:Intubation, Gastrointestinal / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D009864:Ontario; D010290:Parents / Q000193:education / Q000523:psychology*; D011446:Prospective Studies