Stephen B Freedman1, Cindy G Roskind2, Suzanne Schuh3, John M VanBuren4, Jesse G Norris4, Phillip I Tarr5, Katrina Hurley6, Adam C Levine7, Alexander Rogers8, Seema Bhatt9, Serge Gouin10, Prashant Mahajan8, Cheryl Vance11, Elizabeth C Powell12, Ken J Farion13, Robert Sapien14, Karen O'Connell15, Naveen Poonai16, David Schnadower. 1. Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; stephen.freedman@ahs.ca. 2. Department of Emergency Medicine, Medical Center, Columbia University, New York, New York. 3. Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario. 4. Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah. 5. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri. 6. Department of Emergency Medicine, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada. 7. Department of Emergency Medicine, Hasbro Children's Hospital, Rhode Island Hospital and Brown University, Providence, Rhode Island. 8. Departments of Emergency Medicine and Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan. 9. Division of Emergency Medicine, Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 10. Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada. 11. Departments of Emergency Medicine and Pediatrics, School of Medicine, University of California, Davis, Sacramento, California. 12. Department of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 13. Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada. 14. Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. 15. Departments of Pediatrics and Emergency Medicine, School of Medicine and Health Sciences, George Washington University and Children's National Hospital, Washington, DC; and. 16. Departments of Paediatrics, Internal Medicine, and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada.
Abstract
BACKGROUND: Between-country variation in health care resource use and its impact on outcomes in acute care settings have been challenging to disentangle from illness severity by using administrative data. METHODS: We conducted a preplanned analysis employing patient-level emergency department (ED) data from children enrolled in 2 previously conducted clinical trials. Participants aged 3 to <48 months with <72 hours of gastroenteritis were recruited in pediatric EDs in the United States (N = 10 sites; 588 participants) and Canada (N = 6 sites; 827 participants). The primary outcome was an unscheduled health care provider visit within 7 days; the secondary outcomes were intravenous fluid administration and hospitalization at or within 7 days of the index visit. RESULTS: In adjusted analysis, unscheduled revisits within 7 days did not differ (adjusted odds ratio [aOR]: 0.72; 95% confidence interval (CI): 0.50 to 1.02). At the index ED visit, although participants in Canada were assessed as being more dehydrated, intravenous fluids were administered more frequently in the United States (aOR: 4.6; 95% CI: 2.9 to 7.1). Intravenous fluid administration rates did not differ after enrollment (aOR: 1.4; 95% CI: 0.7 to 2.8; US cohort with Canadian as referent). Overall, intravenous rehydration was higher in the United States (aOR: 3.8; 95% CI: 2.5 to 5.7). Although hospitalization rates during the 7 days after enrollment (aOR: 1.1; 95% CI: 0.4 to 2.6) did not differ, hospitalization at the index visit was more common in the United States (3.9% vs 2.3%; aOR: 3.2; 95% CI: 1.6 to 6.8). CONCLUSIONS: Among children with gastroenteritis and similar disease severity, revisit rates were similar in our 2 study cohorts, despite lower rates of intravenous rehydration and hospitalization in Canadian-based EDs.
BACKGROUND: Between-country variation in health care resource use and its impact on outcomes in acute care settings have been challenging to disentangle from illness severity by using administrative data. METHODS: We conducted a preplanned analysis employing patient-level emergency department (ED) data from children enrolled in 2 previously conducted clinical trials. Participants aged 3 to <48 months with <72 hours of gastroenteritis were recruited in pediatric EDs in the United States (N = 10 sites; 588 participants) and Canada (N = 6 sites; 827 participants). The primary outcome was an unscheduled health care provider visit within 7 days; the secondary outcomes were intravenous fluid administration and hospitalization at or within 7 days of the index visit. RESULTS: In adjusted analysis, unscheduled revisits within 7 days did not differ (adjusted odds ratio [aOR]: 0.72; 95% confidence interval (CI): 0.50 to 1.02). At the index ED visit, although participants in Canada were assessed as being more dehydrated, intravenous fluids were administered more frequently in the United States (aOR: 4.6; 95% CI: 2.9 to 7.1). Intravenous fluid administration rates did not differ after enrollment (aOR: 1.4; 95% CI: 0.7 to 2.8; US cohort with Canadian as referent). Overall, intravenous rehydration was higher in the United States (aOR: 3.8; 95% CI: 2.5 to 5.7). Although hospitalization rates during the 7 days after enrollment (aOR: 1.1; 95% CI: 0.4 to 2.6) did not differ, hospitalization at the index visit was more common in the United States (3.9% vs 2.3%; aOR: 3.2; 95% CI: 1.6 to 6.8). CONCLUSIONS: Among children with gastroenteritis and similar disease severity, revisit rates were similar in our 2 study cohorts, despite lower rates of intravenous rehydration and hospitalization in Canadian-based EDs.
Authors: David Schnadower; Phillip I Tarr; T Charles Casper; Marc H Gorelick; J Michael Dean; Karen J O'Connell; Prashant Mahajan; Adam C Levine; Seema R Bhatt; Cindy G Roskind; Elizabeth C Powell; Alexander J Rogers; Cheryl Vance; Robert E Sapien; Cody S Olsen; Melissa Metheney; Viani P Dickey; Carla Hall-Moore; Stephen B Freedman Journal: N Engl J Med Date: 2018-11-22 Impact factor: 91.245
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Authors: Rachael G Horne; Stephen B Freedman; Kathene C Johnson-Henry; Xiao-Li Pang; Bonita E Lee; Ken J Farion; Serge Gouin; Suzanne Schuh; Naveen Poonai; Katrina F Hurley; Yaron Finkelstein; Jianling Xie; Sarah Williamson-Urquhart; Linda Chui; Laura Rossi; Michael G Surette; Philip M Sherman Journal: Front Cell Infect Microbiol Date: 2022-06-14 Impact factor: 6.073