April 13, 2015 - This week's post is also available from the Cochrane Child Health blog.
Fever. Vomiting. Diarrhea.
These are the symptoms that characterize one of the most common pediatric illnesses – Acute Gastroenteritis (AGE). In Canada, AGE accounts for 10% of emergency department visits annually and results in the hospitalization of 1 in 25 children under the age of five, keeping primary care physicians busy as ever [1,2]. Although AGE is not a serious condition in the developed world, it exerts significant economic burden. Estimates suggest Canadian AGE specific costs are $3.7 billion annually .
Despite the prevalence of AGE, its cost, and the ubiquity of its symptomatic presentation, there is no unified approach to its management in emergency departments (ED) institutionally, nationally, or internationally. Standardized, clinical decision tools targeting improvement of gastroenteritis care are not routinely used in Canadian EDs, which can result in variation in clinical decisions for key treatment approaches . In effort to bring easily accessible, up-to-date evidence for AGE treatment approaches to one place, a Cochrane overview of systematic reviews provides a cohesive summary of treatment options and their effectiveness to help clinicians in their evidence-based decision making. This overview included four systematic reviews containing 95 randomized controlled trials involving over 12,000 participants. Here is the key evidence you need to know when treating a child with AGE.
Oral Rehydration Therapy (ORT) versus Intravenous (IV) Rehydration Therapy
Dr. Moshe Ipp, a pediatrician and academic clinician from Toronto, shares his conclusions about this overview in this Cochrane Community podcast:
“In summary, oral rehydration therapy is considered to be the first line choice for rehydration in patients with acute gastroenteritis and mild to moderate dehydration. When there is significant vomiting, ondansetron is the recommended anti-emetic of choice. And probiotics have been shown to be safe and effective for hospitalized children.”
However, Dr. Ipp highlights that ondansetron may not be suitable for all children with AGE: “An interesting finding, and a note of caution, is that in 3 randomized controlled trials there was a higher frequency of diarrhea in the ondansetron group compared to placebo, and because of this finding it is suggested that ondansetron might not be the agent of choice when vomiting is associated with a significant amount of diarrhea.”
Translating Emergency Knowledge for Kids (TREKK):
Cochrane Community Podcast:
 Majowicz, S., McNab, W., Sockett, P., Henson, S., Dore, K., Edge, V., ... & Wilson, J. (2006). Burden and cost of gastroenteritis in a Canadian community. Journal of Food Protection, 69(3), 651-659.
 Alberta Provincial Pediatric Enteric Infection Team. APPETITE seminar series [PDF document]. Retrieved from: Got Gastro Online Website
 Kinlin, L., Bahm, A., Guttmann, A., & Freedman, S. (2013). A survey of emergency department resources and strategies employed in the treatment of pediatric gastroenteritis. Academic Emergency Medicine, 20(4), 361-366. doi: 10.1111/acem.12108
 Freedman, S., Ali, S., Oleszczuk, M., Gouin, S., & Hartling, L. (2013). Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries. Evidence?Based Child Health: A Cochrane Review Journal, 8(4), 1123-1137. doi: 10.1002/ebch.1932