Fellow University of Arkansas for Medical Sciences College of Medicine Little Rock, Arkansas, United States
Background: Ondansetron is a commonly used antiemetic in the Pediatric Emergency Department (PED). The time to administration of ondansetron may influence length of stay (LOS) in the PED, as well as patient disposition. Objective: It is hypothesized that an increase in time to administration (TTA) of ondansetron would increase length of stay (LOS) in the PED. Secondarily, TTA may also increase the likelihood of an admission disposition. Design/Methods: A retrospective chart review was performed of all visits to the PED between January 1st and December 31st, 2019, with complaints of nausea or vomiting, during which the patient was treated with ondansetron. A random sampling of 254 patients were analyzed. The primary outcome variable was assessed with multiple linear regression. The secondary outcome, hospital admission, was examined with multiple logistic regression. Results: Analyzed patients were primarily male (51.6%) and predominately of Caucasian (40.6%) and African American (40.6%) race. The median age at the PED visit was four years of age. TTA in the PED ranged from 6 to 510 minutes with a median of 61 minutes. Significant predictors of LOS in the PED were TTA (p < .001), administration of intravenous fluids (p < .001), and requiring more than one dose of ondansetron (p = .031). These factors accounted for 40% of the variation in PED LOS. Hospital admission was also associated with TTA (p = .026), as well as ondansetron dose (p = .018) and method of ondansetron administration (i.e., oral or IV) (p < .001). The accuracy of this logistic model, also known as the area under the curve (AUC), was 0.73 which results in a fair prediction model. The odds of a hospital stay increased by 2.6 for every increase of 10 minutes in time to ondansetron administration. The IV method of receiving Zofran yielded an odds ratio of 8.4 for a hospital stay and the odds of a hospital stay increased by 1.7 for every increase in 2 mg of dose received.
Conclusion(s): These preliminary results are suggestive of a significant influence of TTA of ondansetron on LOS and disposition in the PED. These results support the importance of decreasing the time to receive ondansetron in the ED as it relates to LOS and hospital admission. Further prospective analyses are warranted to further confirm these findings. Additional results are pending.
