A randomized trial of oral vs intravenous rehydration in a pediatric emergency department

Background: Physicians report several barriers to the use of oral rehydration therapy (ORT) for dehydration in children due to acute gastroenteritis. Objectives: To compare ORT with intravenous therapy for the treatment of moderate dehydration in children with acute gastroenteritis and to determine whether the factors reported as barriers to the use of ORT would be substantiated in practice. Methods: Randomized controlled trial in an urban pediatric emergency department. Children with moderate dehydration due to acute gastroenteritis were randomly assigned to ORT (group 1) or intravenous therapy (group 2). The primary outcome was length of stay in the emergency department. Secondary outcomes included hospital admission rate, staff time, relapse after discharge from the hospital, and parental satisfaction. Two days after discharge, parents were surveyed by telephone to assess the relapse and their satisfaction with the visit. Results: Eighteen patients were enrolled in group 1 and 16 in group 2. The mean length of stay in group 1 was 225 vs 358 minutes in group 2 (P < .01). Mean staff time was 35.8 minutes in group 1 compared with 65 minutes in group 2 (P = .03). Three patients failed ORT and required intravenous therapy. Two patients (11%) in group 1 vs 4 (25%) in group 2 required admission to the hospital (P = .20). No patients relapsed after being discharged from the hospital. Fourteen parents (77%) in group 1 compared with 6 (37.5%) in group 2 reported that they were highly satisfied with all aspects of the visit (P = .01). Conclusions: Reported barriers to ORT were not supported by our data. Moreover, ORT performed better than intravenous therapy on all measured outcomes.