Management of Uncomplicated Acute Gastroenteritis in Pediatric Patients Attending Out-of-Hours Primary Care
Main Article Content
Keywords
Safety netting, Symptomatology, Vomiting, Diarrhea, Fever
Abstract
This study aims to elucidate the trajectory of vomiting, diarrhea, fever, and clinical progression in pediatric patients presenting with uncomplicated acute gastroenteritis in out-of-hours primary care settings. Conducted as a 7-day prospective follow-up study, the course of vomiting, diarrhea, and fever was analyzed using generalized linear mixed modeling. Given the heightened risk of dehydration in infants (≤12 months) and those with severe vomiting, we delineate the potentially more complex courses of these subgroups separately. Additionally, we identify the most common day(s) associated with deterioration and outline the symptoms prevalent in children experiencing such deterioration during follow-up.
Results: Among the 359 children presenting with uncomplicated acute gastroenteritis, 31 (8.6%) experienced complications necessitating referral or hospitalization. The majority of symptoms showed resolution within 5 days in over 90% of cases. Vomiting and fever exhibited rapid decline, while diarrhea demonstrated a slower reduction, particularly among children aged 6–12 months. Notably, children who deteriorated during follow-up exhibited higher rates of vomiting at presentation and elevated frequencies of both vomiting and fever throughout the follow-up period.
Conclusions: Our findings suggest that the frequency of vomiting, rather than its duration, serves as a more significant predictor of deterioration. When counseling parents, it is crucial to provide guidance on typical symptom duration and emphasize recognition of alarm symptoms. Clinicians should maintain vigilance for children with heightened vomiting frequencies upon presentation and during follow-up, as these individuals are at increased risk of deterioration
References
2. De Wit MAS, Kortbeek LM, Koopmans MPG, De Jager CJ, Wannet WJB, Bartelds AIM, et al. A comparison of gastroenteritis in a general practice-based study and a community-based study. Epidemiol Infect. 2001;127(3):389–97.
3. Elliott EJ. Acute gastroenteritis in children. BMJ. 2007;334(7583):35–40.
4. Freedman SB, Ali S, Oleszczuk M, Gouin S, Hartling L. Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries. Evidence-Based Child Heal A Cochrane Rev J. 2013;8(4):1123–37.
5. Belo J, Bos M, Brühl F, Lemmen W, Pijpers M, Van Den Donk M, et al. NHG Standard Acute Diarrhea (third revision). [National Health Guideline - Standard acute diarrhea]. Huisarts & Wetenschap. 7(9):2–20.
6. Van Damme P, Giaquinto C, Huet F, Gothefors L, Maxwell M, Van Der Wielen M. Multicenter prospective study of the burden of rotavirus acute gastroenteritis in Europe, 2004–2005: The REVEAL study. J Infect Dis. 2007;195(SUPPL. 1):2004–5.
7. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H. European society for pediatric gastroenterology, hepatology, and nutrition/european society for pediatric infectious diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: Update 2014. J Pediatr Gastroenterol Nutr. 2014;59(1):132–52.
8. National Collaborating Centre for Women’s and Children’s Health. Diarrhea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years. Diarrhea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years. 2009. 76–89 p.
9. Almond S, Mant D, Thompson M. Diagnostic safety-netting. 2009. p. 872–4.
10. Maguire S, Ranmal R, Komulainen S, Pearse S, Maconochie I, Lakhanpaul M, et al. Which urgent care services do febrile children use and why? Arch Dis Child. 2011;96(9):810–6.
11. Bonvanie I, Weghorst A, Holtman G, Russchen H, Fickweiler F, Verkade H, et al. Oral ondansetron for pediatric gastroenteritis in primary care: a randomized controlled trial. Br J Gen Pract. 2021;71(711):e728-e735.
12. Weghorst A, Holtman G, Bonvanie I, Wolters P, Kollen B, Vermeulen K, et al. Cost-effectiveness of oral ondansetron for children with acute gastroenteritis in primary care: a randomized controlled trial. Br J Gen Pract. 2021;71(711):e736-e743.
13. Weghorst A, Holtman G, Wolters PI, Russchen H, Fickweiler F, Verkade H, et al. Recommendations for clinical research in children presenting to primary care out-of-hours services. BJGP Open. 2021;5(2):bjgpopen20X101154.
14. Freedman SB, Adler M, Seshadri R, Powell EC. Oral Ondansetron for Gastroenteritis in a Pediatric Emergency Department. N Engl J Med. 2006;354(16):1698–705.
15. Carter B, Fedorowicz Z. Antiemetic treatment for acute gastroenteritis in children: An updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework. BMJ Open. 2012;2(4):1–11.
16. Vuletić B, Obradović S, Stojkovic-Andjelković A, Igrutinović Z, Radlović P. Rotavirus gastroenteritis. Srp Arh za Celok Lek. 2006;134(3–4):166–9.
17. Clark HF, Bernstein DI, Dennehy PH, Oft P, Pichichero M, Treanor J, et al. Safety, efficacy, and immunogenicity of a live, quadrivalent human-bovine reassortant rotavirus vaccine in healthy infants. J Pediatr. 2004;144(2):184–90.
18. Sandhu B, Isolauri E, Walker-Smith, et al. Multicentre Study on Behalf of the European Society of Paediatric Gastroenterology and Nutrition Working Group on Acute Diarrhoea. J Pediatr Gastroenterol Nutr. 1997;24(5):522–7.
19. Roslund G, Hepps TS, McQuillen KK. The Role of Oral Ondansetron in Children With Vomiting as a Result of Acute Gastritis/Gastroenteritis Who Have Failed Oral Rehydration Therapy: A Randomized Controlled Trial. Ann Emerg Med. 2008;52(1):22-29.
20. Reeves JJ, Shannon MW, Fleisher GR. Ondansetron decreases vomiting associated with acute gastroenteritis: a randomized, controlled trial. Pediatrics. 2002;109(4):e62.
21. Geneesmiddel Ondansetron Kinderformularium, https://www.kinderformularium.nl/geneesmiddel/30/ondansetron.
22. Kool M, Elshout G, Moll HA, Koes BW, van der Wouden JC, Berger MY. Duration of Fever and Course of Symptoms in Young Febrile Children Presenting with Uncomplicated Illness. J Am Board Fam Med. 2013;26(4):445–52.
23. Friesema IHM, De Boer RF, Duizer E, Kortbeek LM, Notermans DW, Norbruis OF, et al. Etiology of acute gastroenteritis in children requiring hospitalization in the Netherlands. Eur J Clin Microbiol Infect Dis. 2012;31(4):405–15.
24. Evelyn Cohen Reis JGG. Barriers To Use of Oral Rehydration Therapy. 1994;93(5):708–11.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.