Title

Oral versus intravenous: rehydration preferences of pediatric emergency medicine fellowship directors.

Document Type

Article

Publication Date

10-1-2000

Abstract

OBJECTIVE: The American Academy of Pediatrics (AAP) recommends oral rehydration therapy (ORT) for management of uncomplicated childhood gastroenteritis with mild-moderate dehydration. However, ORT is widely underused relative to their recommendations. We compared ORT use by directors of Pediatric Emergency Medicine (PEM) fellowship training programs with AAP recommendations, and sought to identify their barriers to ORT.

METHODS: Mail/fax survey of the directors of U.S. and Canadian PEM fellowship programs. The survey included 10 scenarios of mild or moderately dehydrated children with gastroenteritis, a personal innovativeness scale, self-assessment of ORT experience and knowledge, and open-ended questions regarding perceived barriers to ORT use.

RESULTS: 60/67 (89.6%) PEM fellowship program directors responded. All reported experience with and knowledge about ORT. Only 10/58 (17.2%) believe ORT is usually better than intravenous (i.v.) rehydration in all 10 clinical scenarios, and only 4/58 (6.7%) usually use ORT in all 10 scenarios. 18/58 (31%) usually use ORT for all mildly but no moderately dehydrated children. ORT use did not correlate with personal innovativeness scores. Important barriers cited by respondents include additional time requirements for ORT relative to i.v. rehydration (76.7%) and expectation of i.v. rehydration by parents (41.7%) or primary care physicians (10%).

CONCLUSIONS: Relative to AAP recommendations, PEM fellowship directors underuse ORT, especially for moderately dehydrated children. Physician innovativeness does not influence ORT use. Further study of effectiveness, length of stay, staff requirements, and ORT acceptance in the emergency department setting, especially in children with moderate dehydration, may influence ORT use.

Journal Title

Pediatric emergency care

Volume

16

Issue

5

First Page

335

Last Page

338

MeSH Keywords

Attitude of Health Personnel; Canada; Choice Behavior; Dehydration; Emergency Medicine; Emergency Treatment; Fellowships and Scholarships; Fluid Therapy; Gastroenteritis; Guideline Adherence; Health Knowledge, Attitudes, Practice; Humans; Infusions, Intravenous; Pediatrics; Physician Executives; Practice Guidelines as Topic; Practice Patterns, Physicians'; Surveys and Questionnaires; United States

Keywords

Rehydration; Children; Medical Education; Gastroenteritis

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