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Ondansetron and Bouncebacks – Part Deux

April 16, 2020

Written by Aaron Lacy

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In this study there was no difference in 3-day or 7-day return to the pediatric emergency department (PED) in patients who received an ondansetron prescription versus those who did not for a variety of diagnoses.

Why does this matter?
Ondansetron use in the PED is widespread and the rate of prescribing is increasing. While it has been shown to be relatively safe, there is a lack of literature on its use at home after discharge and its effect on PED bouncebacks. In another retrospective study, there was no difference in the 3-day return rate in AGE patients with a home prescription for ondansetron. If there is no difference in return rates, is it worth prescribing?

A prescription for la nausée
This retrospective analysis of ondansetron prescribing at an urban university teaching hospital gathered data from patients discharged with a diagnosis of acute gastroenteritis (AGE) and those discharged with any diagnosis that had an associated prescription written for ondansetron. Primary outcome was rate of prescription for ondansetron, with one secondary outcome looking at return to the PED in 7 days.  In the AGE group, 71% were discharged with a prescription for ondansetron, with similar 3-day (5% with Rx, 5% without Rx, P=0.75) and 7-day (6% with Rx, 5% without Rx, P=0.66) rate of return to the PED. In the “all diagnoses” group with ondansetron prescriptions, 5% and 6% had return to the PED in 3 and 7 days, respectively. This study expands on the previously linked article above, showing that for all diagnoses, rates of return are similar to rates of return for AGE. However, this study look solely at rates of return. That is not the only reason we prescribe ondansetron. Importantly, as quoted from this article, “…whether this practice has potential to decrease vomiting, no doubt an outcome valued by patients and their parents, has not been clearly answered.”

Ondansetron Prescription for Home Use in a Pediatric Emergency Department. Pediatr Emerg Care. 2020 Mar;36(3):e120-e124. doi: 10.1097/PEC.0000000000001343.

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What are your thoughts?