Revisit rates after emergency department care for pediatric gastroenteritis are similar in the U.S. and Canada even though Canadian EDs have lower rates of intravenous rehydration and hospitalization at the index visit, a new study suggests.
Researchers examined data on patients aged 3 months to 38 months treated in the emergency department in the U.S. (n=588) and Canada (n=827) who were recruited for the study within 72 hours of diagnosis with acute gastroenteritis. Overall, 14 percent of patients had unscheduled health care provider visits within 7 days of recruitment, the primary outcome measured in the study, and there was no significant difference between the U.S. and Canada in this outcome.
At the index visit for acute gastroenteritis, however, patients in the U.S. were significantly more likely than Canadian patients to receive intravenous rehydration (aOR 4.6) and be hospitalized (aOR 3.2).
“In general, after adjustment for illness severity, children received more interventions in the U.S., but it is difficult to say how often these are truly required,” said lead study author Dr. Stephen Freedman, a professor of pediatrics and emergency medicine at Alberta Children’s Hospital & Research Institute and the University of Calgary in Canada.
“One needs to consider this context in the larger picture of health care delivery,” Dr. Freedman said by email. “Whereas the U.S. is more demand-based, the Canadian system is more supply-based.”
Even though the study identified significant differences in the course of treatment between countries, the majority of children in the study didn’t experience the primary outcome.
Fewer children in the U.S. (11.6 percent) than in Canada (17.3 percent) had an unscheduled health care visit within 7 days of study enrollment, a difference that wasn’t statistically significant.
At the index visit for acute gastroenteritis, the proportion of patients receiving intravenous fluid administration was significantly larger in the U.S. (17.0 percent) than in Canada (8.2 percent). Hospitalization also occurred significantly more often in the U.S. (5.3 percent) than in Canada (4.1 percent).
One limitation of the study is that researchers didn’t examine data on pre-scheduled follow-up visits to primary care providers or the ED, the authors note in Pediatrics. The study team also lacked data on patient satisfaction and costs, which might have influenced the outcomes.
There are a number of complex and overlapping issues that determine rates of intravenous rehydration, hospital admission, and unscheduled revisits, said Dr. Marissa Hendrickson, an associate professor of pediatrics at the University of Minnesota Medical School and University of Minnesota Masonic Children’s Hospital in Minneapolis.
“Fortunately, most children with gastroenteritis will get better over the course of a few days without specific treatment,” Dr. Hendrickson, who wasn’t involved in the study, said by email. “However, this is also likely a significant part of the explanation for the fact that intravenous hydration and hospitalization at the index visit were not found to prevent revisits, as those interventions do not cure the underlying illness or necessarily alter its time course.”