Does Ondansetron Mask Alternative Diagnoses in Children with Suspected Gastroenteritis?
Children who received ondansetron were more likely to return and to be admitted at the return visit but were not more likely to be given alternative diagnoses.
Does use of ondansetron in children with suspected gastroenteritis affect likelihood of admission, return visits, or alternative diagnoses? To find out, investigators conducted a retrospective chart review of 34,117 patients (age range, 3 months to 18 years) who received diagnoses of vomiting or gastroenteritis at two tertiary care pediatric emergency departments (EDs) over a 3-year period. Fifty-eight percent of patients received ondansetron.
In logistic regression analyses, patients who received ondansetron were significantly less likely than those who did not receive ondansetron to be admitted on the initial visit (odds ratio, 0.47) but were significantly more likely to return within 72 hours (OR, 1.45) and to be admitted on the return visit (OR, 1.74). Overall, patients who received ondansetron were significantly less likely to be admitted during the initial or return visit (5.3% vs. 7.3%). Of 443 patients who returned and were admitted, 76 (17%) received alternative diagnoses, most often appendicitis (16 patients), intussusception (10), bacteremia (8), and pyelonephritis (7). The likelihood of an alternative diagnosis was not associated with ondansetron use but was significantly associated with documented abdominal pain on the initial visit.
Comment: This large study provides convincing evidence that ondansetron does not usually mask alternative diagnoses in children with suspected gastroenteritis. Therefore, physicians should feel comfortable using this effective antiemetic but continue to consider etiologies of vomiting other than gastroenteritis and provide clear instructions regarding when to return to the ED.
Katherine Bakes, MD
Published in Journal Watch Emergency Medicine May 21, 2010
Citation(s): Sturm JJ et al. Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: Are we masking alternative diagnoses? Ann Emerg Med 2010 May; 55:415.