Ondansetron for acute gastroenteritis: a failure of knowledge translation
Abstract
Acute gastroenteritis (AGE) is one of the most common reasons for children seeking care in the emergency department (ED), accounting for nearly 2 million visits in the United States each year. For children with AGE and mild to moderate dehydration, oral rehydration therapy (ORT) is effective and recommended by the Centers for Disease Control and Prevention1 and American Academy of Pediatrics as first-line therapy. However, vomiting is common in children with AGE and may prevent the success of ORT. Ondansetron, which became available in generic formulation in 2006, is efficacious in reducing vomiting and the need for intravenous (IV) rehydration and hospital admission,2 but little is known about its effectiveness in real-world practice. In this issue of JAMA Pediatrics, Freedman and colleagues3 report the results of a multicenter retrospective cohort study that used time series analysis of Pediatric Health Information System data to determine whether increasing use of ondansetron over the last 10 years in children treated for AGE in US EDs was associated with reduced use of IV hydration and admissions to hospital. Focusing their analysis on 18 hospitals with high-quality data and an adequate range of ondansetron use (n = 804 000), they found that ondansetron use increased dramatically from a median institutional rate of 0.11% in 2002 to 42.2% in 2011. However, as hospitals transitioned from low ( 25%) use of ondansetron—a therapy designed to facilitate oral rehydration and…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 804 participants or records.
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