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Does Ondansetron Impact Meaningful Outcome in Preschoolers?

August 30, 2021

Written by Clay Smith

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Ondansetron reduced the odds of young children needing IV fluid during their index ED visit but didn’t seem to reduce hospitalization or other short term outcomes.

Why does this matter?
Ondansetron is safe in children with mild AGE. Safety, with regard to QT interval, is not as clear in critically ill children. Although we use a lot of ondansetron, does its use impact any clinically meaningful outcomes, like need for IV fluid, hospitalization, or frequency of vomiting?

The AGE old problem

I’m trying something a little different with this summary.* Let me know if you like it or not.

  • Data were initially collected prospectively; this was a planned secondary analysis and is considered retrospective. This cohort included 794 children 3-48 months of age with ≥3 episodes of vomiting. Half of these children were given ondansetron solely at the discretion of the provider. From the 794 kids, they selected 528 (half got ondansetron, half did not) and propensity matched them for relevant clinical characteristics except ondansetron use.

  • With propensity matching, there was a 50% lower odds of IV fluid at the index visit, but there was no decrease in index visit hospitalization rate, 72-hour hospitalization rate, or frequency of vomiting and diarrhea in the 24 hours after the ED visit.

  • Ondansetron reduced the odds of young children needing IV fluid administration, so I plan to keep using it, but it doesn’t appear to have much additional short-term impact.

  • There is certainly some selection bias since ondansetron use was non-randomized and subject to provider discretion. Propensity analysis helped mitigate this to some degree.

Oral Ondansetron Administration in Children Seeking Emergency Department Care for Acute Gastroenteritis: A Patient-Level Propensity-Matched Analysis. Ann Emerg Med. 2021 Aug 11;S0196-0644(21)00478-9. doi: 10.1016/j.annemergmed.2021.06.003. Online ahead of print.

*I am introducing the key study question in the “Why does this matter?” section and then following a mnemonic I made up called DRIL – Design, Results, Implications, and Limitations.

What are your thoughts?