Gastroenteritis Care in the US and Canada: Can Comparative Analysis Improve Resource Use?

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* Abbreviations: AGE — : acute gastroenteritis aOR — : adjusted odds ratio CI — : confidence interval ED — : emergency department IV — : intravenous ORT — : oral rehydration therapy PCP — : primary care physician Acute gastroenteritis (AGE), the most common cause of dehydration in infants and children, accounts for 1.5 million annual outpatient visits and 10% of all pediatric hospital admissions.1–3 Although severely ill children may require intravenous (IV) rehydration, the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommendation for children with mild to moderate dehydration is to use oral rehydration therapy (ORT).1,3 ORT has many benefits when compared with IV rehydration: lower cost, eliminated need for an IV catheter to be placed, shortened emergency department (ED) and hospital stays, improved parental satisfaction, and empowered parents to continue therapy at home.1,3,4 Additionally, a meta-analysis comparing ORT with IV rehydration revealed low risk of treatment failure for ORT (<5%).4 Despite these advantages, IV rehydration is still commonly used for mild to moderate dehydration in AGE, with wide interinstitutional and interprovider practice variation.5,6 In this issue of Pediatrics , Freedman et al compare resource use and outcomes among children with AGE enrolled in 1 of 2 ED-based randomized controlled trials of probiotics conducted by the Pediatric Emergency Care Applied … Address correspondence to Alexandra H. Baker, MD, Boston Children’s Hospital, Main 1 Emergency, 300 Longwood Ave, Boston, MA 02115. E-mail: alexandra.baker{at}childrens.harvard.edu