The Hospital for Sick Children, The University of Toronto, Toronto, Canada.
J Pediatr Gastroenterol Nutr. 2012 Mar;54(3):381-6. doi: 10.1097/MPG.0b013e31822ecaac.
Emergency department use of ondansetron in children with gastroenteritis is increasing; however, its effect on clinical outcomes is unknown. We aimed to determine whether increasing ondansetron usage is associated with improved outcomes in children with gastroenteritis.
A retrospective cohort study was conducted at The Hospital for Sick Children, Toronto, Canada. Eligible children included those younger than 18 years old with gastroenteritis who presented to an emergency department between 2003 and 2008. There were 22,125 potentially eligible visits; 20% were selected at random for chart review. The primary outcome measure, the intravenous rehydration rate, was evaluated using an interrupted time-series analysis with segmented logistic regression. Secondary outcomes included emergency department revisits, hospitalization, and length of stay.
A total of 3508 patient visits were included in the final analysis. During the study period, there was a significant reduction in intravenous rehydration usage (27%-13%; P < 0.001) and an increase in ondansetron administration (1%-18%; P < 0.001). Time-series analysis demonstrated a level break (P = 0.03) following the introduction of ondansetron. The mean length of stay for children declined from 8.6 ± 3.4 to 5.9 ± 2.8 hours, P = 0.03. During the week following the index visit, there was a reduction in return visits (18%-13%; P = 0.008) and need for intravenous rehydration (7%-4%; P = 0.02).
Ondansetron use has increased significantly and is associated with reductions in the use of intravenous rehydration, emergency department revisits, and length of stay. The selective use of ondansetron is associated with improved clinical outcomes.
在患有肠胃炎的儿童中，急诊室使用昂丹司琼的情况越来越多；然而，其对临床结果的影响尚不清楚。我们旨在确定昂丹司琼使用量的增加是否与肠胃炎患儿的转归改善相关。
这是一项在加拿大安大略省多伦多 SickKids 医院进行的回顾性队列研究。纳入标准为 2003 年至 2008 年间因肠胃炎就诊于急诊室的年龄小于 18 岁的儿童。共有 22125 例潜在符合条件的就诊，其中 20%随机选择进行病历回顾。主要结局指标为静脉补液率，采用分段逻辑回归中断时间序列分析进行评估。次要结局指标包括急诊复诊、住院和住院时间。
共有 3508 例患者就诊纳入最终分析。在研究期间，静脉补液使用率（27%降至 13%；P<0.001）显著降低，而昂丹司琼使用率（1%增至 18%；P<0.001）则增加。时间序列分析显示，在引入昂丹司琼后出现了一个水平断点（P=0.03）。患儿的平均住院时间从 8.6±3.4 小时降至 5.9±2.8 小时，P=0.03。在就诊后的一周内，复诊率（18%降至 13%；P=0.008）和静脉补液需求（7%降至 4%；P=0.02）均降低。
昂丹司琼的使用显著增加，与静脉补液、急诊复诊和住院时间的减少相关。昂丹司琼的选择性使用与临床结局的改善相关。
