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A prospective comparative study of children with gastroenteritis: emergency department compared with symptomatic care at home

  • Otto G. Vanderkooi
  • Jianling Xie
  • Bonita E. Lee
  • Xiao-Li Pang
  • Linda Chui
  • Daniel C. Payne
  • Judy MacDonald
  • Samina Ali
  • Shannon MacDonald
  • Steve Drews
  • Lara Osterreicher
  • Kelly Kim
  • Stephen B. FreedmanEmail author
  • on behalf of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) and Pediatric Emergency Research Canada (PERC)
Original Article
  • 52 Downloads

Abstract

Little is known about the epidemiology and severity of gastroenteritis among children treated at home. We sought to compare illness severity and etiology between children brought for emergency department (ED) care to those managed at home (i.e., community). Prospective cohort study of children enrolled between December 2014 and December 2016 in two pediatric EDs in Alberta, Canada along with children treated at home after telephone triage (i.e., community). Primary outcomes were maximal frequency of vomiting and diarrhea in the 24-h pre-enrollment period; secondary outcomes included etiologic pathogens, dehydration severity, future healthcare visits, and treatments provided. A total of 1613 patients (1317 ED, 296 community) were enrolled. Median maximal frequency of vomiting was higher in the ED cohort (5 (3, 10) vs. 5 (2, 8); P < 0.001). Proportion of children with diarrhea and its 24-h median frequency were lower in the ED cohort (61.3 vs. 82.8% and 2 (0, 6) vs. 4 (1, 7); P < 0.001, respectively). In regression analysis, the ED cohort had a higher maximum number of vomiting episodes pre-enrollment (incident rate ratio (IRR) 1.25; 95% CI 1.12, 1.40) while the community cohort had higher maximal 24-h period diarrheal episodes (IRR 1.20; 95% CI 1.01, 1.43). Norovirus was identified more frequently in the community cohort (36.8% vs. 23.6%; P < 0.001). Children treated in the ED have a greater number of vomiting episodes; those treated at home have more diarrheal episodes. Norovirus is more common among children treated symptomatically at home and thus may represent a greater burden of disease than previously thought.

Keywords

Child Gastroenteritis Emergency service Hospital Vomiting Diarrhea Norovirus 

Abbreviations

AGE

acute gastroenteritis

ED

emergency department

IQR

inter-quartile range

IRR

incidence rate ratio

Notes

Acknowledgments

We would like to thank the following: Dr. M. Louie (Alberta Public Laboratories), Dr. Alberto Nettel-Aguire (project design support), Ms. Karen Lowerison, Bryanne Crago, Christina Ferrato (CLS), and Dr. Judy Qiu (Dr. Pang’s research team), the assistance of Calgary Laboratory Services, DynaLIFE Dx Diagnostic Laboratory Services, community laboratories, as well as Provincial Laboratory for Public Health (ProvLab), Edmonton and Calgary, Alberta, especially the staff for their assistance with specimen receiving, handling, and processing; the emergency department research nurses and the Pediatric Emergency Medicine Research Associate Program (PEMRAP) at the Alberta Children’s Hospital for recruiting study participants, the emergency department bedside nurses for assisting with rectal swab performance; Ms. Nadia Dow and Manasi Rajagopal, as well as the research assistants, research nurses, and Little Bit of Help (LBoH) research volunteer program for their assistance with participant recruitment at the Stollery Children’s Hospital; and the nurses at Health Link who respond to calls from across the province for their assistance with participant recruitment. No compensation for the assistance of any aforementioned individuals was provided.

Contributor’s statement

Dr. Vanderkooi conceptualized and designed the study, acquired and interpreted the data, conducted the analyses, drafted the initial manuscript, provided administrative, technical or material support, and reviewed and revised the manuscript.

Dr. Freedman had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He additionally obtained funding, conceptualized and designed the study, acquired and interpreted the data, conducted the analyses, drafted the initial manuscript, provided administrative, technical or material support, and reviewed and revised the manuscript.

Dr. Xie conducted the analyses, acquired and interpreted the data, provided administrative, technical or material support, and critically reviewed the manuscript for important intellectual content.

Drs Judy MacDonald, Shannon MacDonald and Payne conceptualized and designed the study, and critically reviewed the manuscript for important intellectual content.

Ms. Osterreicher conceptualized and designed the study, provided administrative, technical or material support, and critically reviewed the manuscript for important intellectual content.

Drs. Lee, Chui and Pang acquired and interpreted the data, obtained funding provided administrative, technical or material support, and critically reviewed the manuscript for important intellectual content.

Dr. Ali acquired and interpreted the data and critically reviewed the manuscript for important intellectual content.

Dr. Nettel-Aguirre provided statistical analysis and critically reviewed the manuscript for important intellectual content.

Dr. Drews acquired and interpreted the data and critically reviewed the manuscript for important intellectual content.

Dr. Louie conceptualized and designed the study, obtained funding and critically reviewed the manuscript for important intellectual content.

Ms. Kim and Lowerison provided administrative, technical or material support and acquired and interpreted the data.

All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Funding information

This research is supported by the Alberta Provincial Pediatric Enteric Infection TEam (APPETITE), which is funded by a grant from the Alberta Innovates-Health Solutions Team Collaborative Innovation Opportunity. APPETITE is also supported by the Alberta Children’s Hospital Research Institute (Calgary, Alberta) and the Women and Children’s Partnership Award Health Research Institute (Edmonton, Alberta). Dr. Freedman is supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness. The Pediatric Emergency Medicine Research Associate Program (PEMRAP) is supported by a grant from the Alberta Children’s Hospital Foundation. In-kind support to enable the conduct of this study is provided by Calgary Laboratory Services, ProvLab Alberta, Luminex Corporation, and Copan Italia.

Compliance with ethical standards

Approvals were obtained from the Universities of Calgary and Alberta Health Research Ethics Boards. Informed consent was provided by caregivers or legal guardians; child assent was obtained as required

Disclaimer

None of the funders had any input into the design or conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Conflict of interest

The authors declare that they have conflict of interest.

Supplementary material

10096_2019_3688_MOESM1_ESM.docx (105 kb)
ESM 1 (DOCX 104 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Otto G. Vanderkooi
    • 1
  • Jianling Xie
    • 2
  • Bonita E. Lee
    • 3
  • Xiao-Li Pang
    • 4
  • Linda Chui
    • 4
  • Daniel C. Payne
    • 5
  • Judy MacDonald
    • 6
  • Samina Ali
    • 3
  • Shannon MacDonald
    • 7
  • Steve Drews
    • 8
  • Lara Osterreicher
    • 9
  • Kelly Kim
    • 10
  • Stephen B. Freedman
    • 11
    Email author
  • on behalf of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) and Pediatric Emergency Research Canada (PERC)
  1. 1.Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences and the Alberta Children’s Hospital Research InstituteUniversity of CalgaryCalgaryCanada
  2. 2.Section of Pediatric Emergency Medicine, Alberta Children’s HospitalUniversity of CalgaryCalgaryCanada
  3. 3.Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children’s Health Research InstituteUniversity of AlbertaEdmontonCanada
  4. 4.Public Health Laboratory (ProvLab), Alberta Public Laboratories, Edmonton, Alberta, Canada and the Department of Laboratory Medicine and PathologyUniversity of AlbertaEdmontonCanada
  5. 5.National Center for Immunization and Respiratory Diseases, Division of Viral DiseasesUS Centers for Disease Control and PreventionAtlantaUSA
  6. 6.Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
  7. 7.Faculty of Nursing, University of Alberta, School of Public Health, University of Alberta & Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
  8. 8.Department of Laboratory Medicine and PathologyUniversity of AlbertaEdmontonCanada
  9. 9.Provincial Clinical Programs, Health LinkAlberta Health ServicesEdmontonCanada
  10. 10.Department of PediatricsCalgaryCanada
  11. 11.Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of MedicineUniversity of CalgaryCalgaryCanada

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