Ondansetron Rx and Bouncebacks to the PED

October 14, 2019

Written by Aaron Lacy

Spoon Feed
In children with suspected acute gastroenteritis there was no significant association with the rate of return visits in those who were sent home with a prescription for ondansetron and those who were not.

Why does this matter?
Originally marketed for the prevention of nausea and vomiting associated with chemotherapy, off-label use for all-cause nausea and vomiting has led ondansetron to become one of the most commonly prescribed drugs in EDs.  While ondansetron is relatively safe, some studies raise concern that its use shifts therapeutic focus away from oral fluid therapy and may mask alternative diagnoses. Is prescribing ondansetron worth the risk if it doesn’t change the rate of bounce-backs in children with gastroenteritis?

Stomaching the results
This was a retrospective comparative cohort study conducted at a tertiary urban pediatric ED. Illness severity and dehydration scores were used to statistically adjust for severity of illness. The primary outcome was unscheduled ED revisit within 3 days of discharge. The secondary outcome was an alternative diagnosis other than acute gastroenteritis at the return visit.

Over a 5-year study period, 11,785 patients were identified, with an average age of 3.5 years.  Around a third (35.5%) of patients were discharged with a prescription for ondansetron. Of the original 11,785 patients, 510 (4.3%) returned to the ED within 72 hours. In those prescribed vs not prescribed ondansetron, there was no significant difference in the proportion returning to the ED within 72 hours (aOR 1.12, 95%CI 0.92-1.33) or in the proportion with alternative diagnoses (aOR 0.56, 95%CI 0.20-1.59). Though not addressed by this study, an ondansetron prescription my provide parents peace of mind and may also give symptomatic relief for the child. I still foresee myself offering a prescription of ondansetron to children for those reasons, with the knowledge that it may not prevent me from receiving an EMR notification of a bounce-back.

Source
Impact of Ondansetron Prescription on Return Emergency Department Visits Among Children with Acute Gastroenteritis. Pediatr Emerg Care. 2019 Sep 12. doi: 10.1097/PEC.0000000000001907. [Epub ahead of print]

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Reviewed by Clay Smith and Thomas Davis