Pediatric gastroenteritis in the emergency department: practice evaluation in Belgium, France, The Netherlands and Switzerland
1 Department General Pediatrics, CHI de Creteil, Creteil, France
2 Pediatric Emergency Department, Queen Fabiola Hospital, Brussels, Belgium
3 Department of Pediatric Emergency, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
4 Department of Medical and Surgical Pediatric, Hôpital du Valais, Centre Hospitalier du Valais Romand, Sion, Switzerland
5 Department General Pediatrics, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
6 Department General Pediatrics, Erasmus MC-Sophia Hospital, Rotterdam, Netherlands
7 Pediatric Department, AP-HP, Hôpital Antoine Béclère and Université Paris 11, Clamart, France
8 Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development Team, Villejuif, France
9 Department of Pediatric Emergency, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, 149 rue de Sèvres, 75015 Paris, France
BMC Pediatrics 2014, 14:125 doi:10.1186/1471-2431-14-125Published: 16 May 2014
Based on European recommendations of ESPGHAN/ESPID from 2008, first line therapy for dehydration caused by acute gastroenteritis (AGE) is oral rehydration solution (ORS). In case of oral route failure, nasogastric tube enteral rehydration is as efficient as intra-venous rehydration and seems to lead to fewer adverse events. The primary objective was to describe rehydration strategies used in cases of AGE in pediatric emergency departments (PEDs) in Belgium, France, The Netherlands, and Switzerland.
An electronic survey describing a scenario in which a toddler had moderate dehydration caused by AGE was sent to physicians working in pediatric emergency departments. Analytical data were analyzed with descriptive statistics and Kruskal –Wallis Rank test.
We analyzed 68 responses, distributed as follows: Belgium N = 10, France N = 37, The Netherlands N = 7, and Switzerland N = 14. Oral rehydration with ORS was the first line of treatment for 90% of the respondents. In case of first line treatment failure, intravenous rehydration was preferred by 95% of respondents from France, whereas nasogastric route was more likely to be used by those from Belgium (80%), The Netherlands (100%) and Switzerland (86%). Serum electrolyte measurements were more frequently prescribed in France (92%) and Belgium (80%) than in The Netherlands (43%) and Switzerland (29%). Racecadotril was more frequently used in France, and ondansetron was more frequently used in Switzerland. No respondent suggested routine use of antibiotics.
We found variations in practices in terms of invasiveness and testing. Our study supports the need for further evaluation and implementation strategies of ESPGHAN/ESPID guidelines. We plan to extend the study throughout Europe with support of the Young ESPID Group.