GI, Improving Outcomes, Improving Throughput, Mythbusting, Pediatrics, Pediatrics, Pediatrics

Stop with the IV Zofran for Peds Gastroenteritis.

Quick:

How much does a liter of Normal Saline cost?

If you said $400 or more, you win, and if you ordered it without PO challenging your patient, your patient just lost. Now for children, ask a parent what they would rather prefer – having their terrified & vomiting child stuck few times & made miserable – all for over $400! – or an attempt at giving the same medication orally to watch and see how the child does?

Put it that way, and parents now see the light. Bottom line is that they do not want to see their child suffer any more than we want to hear them yell down the hall after getting stuck 4 times. And besides, how much of that liter of Normal Saline that you ordered gets placed intravascularly?

Screen Shot 2014-03-15 at 1.14.56 PM

about an 8oz can of delicious Shasta Ginger Ale. ( or about 25 %

The Evidence:

A Cochrane Review found the NNT from providing oral Zofran reduced hospital admissions (NNT: 17), and oral zofran / oral hydration vs IV Zofran / IV hydration made no difference in 72 hour bounceback or readmission – treat 6 patients with PO hydration first to prevent 1 IV placement.

A separate Cochrane Review found 1 in 33 patients given oral Zofran developed a paralytic ileus, but this was no different than the recommended low osmolarity solutions recommended by the World Health Organization. For every 25 children treated with PO Zofran, one would fail and require an IV.

Its part of the Choosing Wisely Campaign. I’ve had conversations with parents about IV or PO zofran, and most prefer not have their child tortured. They leave the ED sooner and happier, without compromising safety. Document a repeat abdominal exam, give good belly precautions to family, and you have saved everyone a good bit of time and hassle.

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Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework.  PMID: 22815462 
Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. PMID: 16856044
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