Objective: To evaluate the association of emergency department (ED) ondansetron with hospitalization with acute gastroenteritis (AGE) in children. Methods: We conducted a retrospective study using the PECARN Registry of children with AGE. Within a sample matched on vital signs, demographics, clinical severity, imaging performance, and intravenous fluids provision, we used conditional logistic regression to assess associations between administration of ondansetron and hospitalization. We compared rates of 7-day return visits with significant diagnoses between children who did and who did not receive ondansetron on their initial encounter. Results: We included 543,541 encounters, of which ondansetron was administered in 39.7%. After matching, hospital admission occurred in 11.8% and 17.7% of children who did and did not receive ondansetron, respectively, with standardized mean differences <0.1. Ondansetron was negatively associated with hospitalization (OR: 0.61, 95% CI: 0.60-0.63). Children given ondansetron on their index visit had a higher percentage of 7-day return visits with appendicitis (absolute percentage difference, +0.05%, 95% CI: +0.03%, +0.07%), but a lower percentage of return visits with sepsis or bacteremia (−0.03%, 95% CI: −0.05%, −0.01%) compared with children not given ondansetron on their index visit. Conclusions: Children receiving ondansetron for AGE in the ED had an ∼40% lower odds of hospitalization. While appendicitis was diagnosed more frequently within 7 days among children given ondansetron compared with those not given ondansetron, sepsis or bacteremia were less frequently diagnosed. These findings align with prospective studies demonstrating the beneficial impact of ondansetron use in pediatric AGE.
Ramgopal et al. (Mon,) studied this question.