443 - Ondansetron Use in Primary Care and Subsequent Emergency Department Visits in Children with Gastroenteritis

Publication Number: 443.5603

Jamar Borland, Nemours Children's Hospital, KISSIMMEE, FL, United States; Michael T. Hsieh, UCF College Of Medicine, San Ramon, CA, United States; Andrea Rivera-Sepulveda, Nemours Children’s Health, Orlando, FL, United States

Background: Ondansetron use in the emergency department (ED) for acute gastroenteritis (AGE) has proven effective in halting vomiting, decreasing ED resource use, decreasing ED length of stay, and decreasing ED return visits. However, the literature on ondansetron use in primary care clinics (PCCs) is limited.

Objective: This study aims to assess whether administering ondansetron in PCCs decreases subsequent ED visits and ED resource use in children with AGE.

Design/Methods: This retrospective cohort study included children aged 6 months to 18 years old who visited a PCC within our healthcare system network with a complaint of vomiting, diarrhea, or AGE between January 1, 2017 and December 31, 2023. Variables included the administration or prescription of ondansetron during their PCC visit, ED visit within 7 days of PCC visit with the same complaint, ED resource use, and ED disposition. Kruskal-Wallis test and chi-square test were used to compare groups, as indicated. Continuous outcomes were summarized with linear regression, binary outcomes were summarized with logistic regression, and ordinal outcomes were summarized with negative binomial regression.

Results: We identified 35,000 encounters with 11,343 unique patients that met inclusion criteria. One-third (33%) of children who visited the PCC were prescribed ondansetron, with 21% receiving their initial dose at the PCC. About 0.6% of children who were prescribed ondansetron (vs. 0.5% without prescription) visited the ED within 7 days of their PCC visit (p=0.80). About 1.2% of children who received ondansetron at the PCC (vs. 0.5% who did not) did visit the ED within 7 days of their PCC visit (p=0.02). The unadjusted model showed that an ED visit within 7 days for children with AGE was associated with receiving ondansetron at the PCC (OR 2.7, 95%CI 1.1-6.2), ED medication use (OR 184.5, 95%CI 103-351.9), ED laboratory workup (OR 123.1, 95%CI 72.7-212.5), and ED radiograph (OR 99.6, 95%CI 57.2-171.9), but not ondansetron prescription (OR 1.1, 95%CI 0.6-1.8). Regression analysis showed no significance in the prescription of ondansetron at a PCC and its association with acuity level, ED length of stay, or ED disposition.

Conclusion(s): Prescribing ondansetron at the PCC does not mitigate the likelihood of subsequent ED visits within 7 days among children with AGE, nor demonstrates a significant reduction in ED resource use. Further studies are needed to explore alternative strategies or interventions aimed at reducing the need for emergency care in this population and examine the efficacy of ondansetron in mitigating ED visits when prescribed or given at the PCC.

Table 1. Distribution of selected demographic and clinical characteristics of children with gastroenteritis who visited the PCC and had a subsequent emergency department within 7 days (N=11,343).
ED = emergency department, IQR = interquartile range, PCC = primary care clinic.

Table 2. Effect of Ondansetron Use from PCC on Subsequent ED Visits within 7 days (N=11,343).
ED = emergency department, PCC = primary care clinic.

Table 3. Logistic regression of variables associated with ED visit within 7 days of PCC visit in children with AGE.
AGE = acute gastroenteritis, CI = confidence interval, ED = emergency department, OR = odds ratio, PCC = primary care clinic.

Table 1. Distribution of selected demographic and clinical characteristics of children with gastroenteritis who visited the PCC and had a subsequent emergency department within 7 days (N=11,343).
ED = emergency department, IQR = interquartile range, PCC = primary care clinic.

Table 2. Effect of Ondansetron Use from PCC on Subsequent ED Visits within 7 days (N=11,343).
ED = emergency department, PCC = primary care clinic.

Table 3. Logistic regression of variables associated with ED visit within 7 days of PCC visit in children with AGE.
AGE = acute gastroenteritis, CI = confidence interval, ED = emergency department, OR = odds ratio, PCC = primary care clinic.