A novel approach to the rehydration of children with gastroenteritis in the emergency department
Abstract
Background Children with gastroenteritis comprise 6% of all Emergency Department presentations and with growing pressure to complete care in six hours, a rehydration Best Care Bundle (BCB) was created to deliver evidence based but timely interventions to children presenting to the emergency departments (ED) at Waitemata District Health Board (WDHB). Method A modified systematic review was undertaken to validate the interventions in the BCB and to identify additional interventions from the best available contemporary evidence. A search was executed through Medline, Cinahl and Scopus focussing on the last 5 years and those studies published in English. Results Forty one articles were retrieved and appraised; the outcome measures were collated and compared with the BCB interventions. The use of a categorical hydration assessment scale and the components thereof were consistent with contemporary best practice although the evidence suggests that clinical sign based scales have better sensitivity than specificity and are most accurate for predicting severe dehydration. The use of (low osmolality) oral rehydration solutions (ORS) to rehydrate mild to moderately dehydrated children was confirmed to be effective and associated with fewer adverse effects than intravenous fluids (IVF). The BCB promotes nasogastric (NG) rehydration in young children with dehydration but not severe dehydration where oral rehydration therapy (ORT) failed and was shown to reduce the need for IV fluids. IV…
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