Does providing an ondansetron prescription to pediatric patients discharged from the emergency department with presumed diagnosis of acute gastroenteritis decrease rate of repeat ED visit?

Background: This is a clinically important question for 2 reasons: 1) can provide patient/caretaker with symptomatic relief at home, 2) concern for masking an alternative diagnosis and delaying/preventing return visit.

Bottom Line: Providing a prescription for ondansetron upon emergency department discharge of pediatric patients with presumed diagnosis of acute gastroenteritis does not change the rate of return visit.

Study 1, Gray et al. Ondanestron Prescription for Home Use in a Pediatric Emergency Department

Retrospective chart review at single center including all patients age 0-18 years presenting to ED from 2012-2014 discharged with ICD-9 code for acute gastroenteritis with a separate overlapping group of all pediatric patients who received a prescription for ondansetron upon discharge. 

• 996 patients discharged with diagnosis of acute gastroenteritis, 2287 discharged with prescription for ondansetron
• Primary outcome was rate of prescription: 71% received prescription
• Secondary outcome: Return to ED within 7 days of initial visit; rate of return was 5-6% in all groups despite prescription. No statistically significant difference (see below).

Limitations: 

• Retrospective chart review design - room for bias, confounders
• Does not provide further information regarding illness severity or ED course
• No attempt to determine if patient returned to different institution, filled prescription, or was ondansetron adminstered at home even if prescription was filled 

Study 2, McLaren et al. Impact of Ondansetron Prescription on Retrun Emergency Department Visits Among Children with Acute Gastroenteritis

Retrospective comparative cohort study at single emergency department from 2010-2015 including patients age 6 months-18 years with discharge diagnosis of acute gastroenteritis (ICD-9 code). Excluded patients with exclusively diarrhea and any comorbid condition.

• Primary outcome: unscheduled ED visit within 3 days of discharge, aOR 1.12, 95% CI 0.92-1.33
•  Secondary outcome: alternative diagnosis other than acute gastroenteritis on return visit, aOR 0.56, 95% CI 0.20-1.59

A

Advantages compared to first study:

• Attempt to limit confounding by performing multivariate logistic regression
• More information regarding illness severity and treatment between groups
• Performs sample size calculation to ensure adequately powered

Limitations: 

• Retrospective design - room for bias 
• No attempt to determine if patient returned to different institution, filled prescription, or was ondansetron adminstered at home even if prescription was filled 

References:

1. Gray, J, et al. Ondansetron Prescription for Home Use in a Pediatric Emergency Department. Pediatric Emergency Care, 2020; 36(3): e120-e124

2. McLaren, S, et al. Impact of Ondansetron Prescription on Return Emergency Department Visits Among Children with Acute Gastroenteritis. Pediatric Emergency Care.