Dehydration pathway for pediatric gastroenteritis may cut resource use, costs

Last Updated: 2020-06-02

By Reuters Staff

NEW YORK (Reuters Health) - Implementation of an evidence-based algorithm for managing pediatric gastroenteritis was followed by a significant reduction in IV-fluid administration and cost of care, researchers report.

Practice guidelines from the American Academy of Pediatrics favor the use of oral rehydration therapy (ORT) over IV rehydration for treating dehydration secondary to gastroenteritis. But ORT remains widely underused, Dr. Jessica K. Creedon and colleagues from Boston Children's Hospital note in Pediatrics.

The authors aimed to reduce their 15% rate of IV rehydration to less than 10% in previously healthy patients presenting to the emergency department (ED) with mild to moderate gastroenteritis-related dehydration within 12 months.

The primary intervention was the development and implementation of an evidence-based guideline (EBG) that targeted children aged 6 months to 6 years who presented to the ED with vomiting and/or diarrhea and presumed gastroenteritis.

The algorithm's initial treatment recommendation was based on the patient's dehydration score (out of 10 total points): oral rehydration for patients with a score <3; oral rehydration with reassessment after 30 minutes to determine if the patient is drinking adequately for a score of 3-6; and IV fluids for a score >6. The tool was embedded in the electronic medical record (EMR).

After implementation of the algorithm, IV-fluid usage in patients with gastroenteritis-related dehydration dropped by 60%, from a mean of 15% to 9%.

Among children with mild to moderate dehydration (score <7), IV-fluid usage halved, from 16% to 8%.

Total healthcare costs associated with the entire episode of care fell by $189 after implementation from the pre-implementation average of $599.

In addition, ED length of stay decreased from a median of 180 minutes to 156 minutes for the entire group of participants and decreased from a median of 183 to 156 minutes among patients with mild-to-moderate dehydration scores.

There was no increase in the balancing measure of admission rate and the rate of return visit within 72 hours.

"The gastroenteritis EBG appears to be a cost-effective strategy resulting in a 32% reduction in total cost of care," the authors conclude.

Dr. Creedon did not respond to a request for comments.

SOURCE: https://bit.ly/2AtvVVF Pediatrics, online June 2, 2020.