Pediatric Emergency Medicine Fellow Corewell Health/Beaumont Royal Oak Windsor, Ontario, Canada
Background: Gastroenteritis and dehydration are some of the leading causes of morbidity within pediatric EDs in the US, with over 1.7 million visits and more than 70,000 hospitalizations. There are many different guidelines/standards on the definition of dehydration. Clinical exam guidance using dehydration scales have been explored (eyes, mucous membranes, and tears). However, use of them in practice is varied. Electrolyte lab values have not been included in dehydration scales, as a cut off is difficult to determine to guide IV vs oral rehydration, or admission. There can be little overlap between clinical exam and laboratory results. Studies have shown that closer bicarbonate level to normal indicated a shorter hospital stay. However, no difference in admission rate, short stays and ED revisits for those who received IV fluids in large amounts or small. Research has shown 4.3% of children discharged from the ED with gastroenteritis will return within 72 hours, and up to 18% within 7 days. Previous studies have shown no true trend to follow. Objective: Explore whether an association exists between clinical status/laboratory values such as bicarbonate level and subsequent management/disposition of children between ages 6 months to 10 years presenting to ED with potential dehydration related to gastroenteritis. Secondary aim is to evaluate length of stay, number of boluses and disposition of patients. Design/Methods: Retrospective observational review of all pediatric patients, age 6 months - 10 years, with discharge diagnosis of nausea, vomiting, diarrhea, dehydration or gastroenteritis in the ED over 1 year (2/2019 – 2/2020). IRB approval for study received. Exclusion criteria were children with chronic surgical/medical conditions that could cause labile electrolytes. Variables of interest were demographics, lab values (bicarbonate, sodium, chloride, potassium, BUN, creatinine, anion gap), zofran use, disposition, return visits within 72 hours, ED length of stay, IV fluids. Timeline includes obtaining all data this month and analysis to be completed before end of December 2023.
