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Time-series Analysis of Ondansetron Use in Pediatric Gastroenteritis

Freedman, Stephen B.*; Tung, Connie; Cho, Dennis; Rumantir, Maggie*; Chan, Kevin J.*

Journal of Pediatric Gastroenterology and Nutrition: March 2012 - Volume 54 - Issue 3 - p 381–386
doi: 10.1097/MPG.0b013e31822ecaac
Original Articles: Gastroenterology

Objective: Emergency department use of ondansetron in children with gastroenteritis is increasing; however, its effect on clinical outcomes is unknown. We aimed to determine whether increasing ondansetron usage is associated with improved outcomes in children with gastroenteritis.

Methods: A retrospective cohort study was conducted at The Hospital for Sick Children, Toronto, Canada. Eligible children included those younger than 18 years old with gastroenteritis who presented to an emergency department between 2003 and 2008. There were 22,125 potentially eligible visits; 20% were selected at random for chart review. The primary outcome measure, the intravenous rehydration rate, was evaluated using an interrupted time-series analysis with segmented logistic regression. Secondary outcomes included emergency department revisits, hospitalization, and length of stay.

Results: A total of 3508 patient visits were included in the final analysis. During the study period, there was a significant reduction in intravenous rehydration usage (27%–13%; P < 0.001) and an increase in ondansetron administration (1%–18%; P < 0.001). Time-series analysis demonstrated a level break (P = 0.03) following the introduction of ondansetron. The mean length of stay for children declined from 8.6 ± 3.4 to 5.9 ± 2.8 hours, P = 0.03. During the week following the index visit, there was a reduction in return visits (18%–13%; P = 0.008) and need for intravenous rehydration (7%–4%; P = 0.02).

Conclusions: Ondansetron use has increased significantly and is associated with reductions in the use of intravenous rehydration, emergency department revisits, and length of stay. The selective use of ondansetron is associated with improved clinical outcomes.

*Division of Paediatric Emergency Medicine, The Hospital for Sick Children, The University of Toronto, Toronto

the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.

Address correspondence and reprint requests to Stephen B. Freedman, MDCM, MSc, FRCPC, Division of Paediatric Emergency Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada (e-mail:

Received 12 May, 2011

Accepted 20 July, 2011

This study was presented at 2010 Pediatric Academic Societies’ annual meeting; Vancouver, BC; May 1, 2010 and the Canadian Pediatric Society's 87th annual conference; Vancouver, BC; June 23, 2010.

S.B.F. received research support from GlaxoSmithKline in 2003 but has not had any relationship with them since. He receives research support from Institut Rosell Lallemand Inc. K.J.C. previously received research support from GlaxoSmithKline (2000–2004) but has not had any relationship with them since.

Copyright 2012 by ESPGHAN and NASPGHAN