ondansetron for gastroenteritis in a pediatric emergency depart- ment. New Engl J Med 2006;354:1698-705. This was a prospective, randomized trial of oral ...
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COMMENTARY
Paediatric emergency research highlights 2006-2007 David McGillivray MD
T
he following articles were selected from the paediatric emergency literature of the past year. They have been selected based on four criteria – scientific quality, relevance to physicians caring for children, problems dealing with high acuity or prevalence, and topics that may lead to a change in care.
positive urinalysis compared with the blood culture-negative group. This study will potentially reduce the number of blood cultures taken and increase the number of urine examinations. A note of caution is that the findings can only be extrapolated to febrile children who live in an area where pneumococcal vaccination is routinely given.
PAEDIATRIC BACTEREMIA AS A MOVING TARGET Herz AM, Greenhow TL, Alcantra J, et al. Changing epidemiology of outpatient bacteremia in 3- to 36-month-old children after the introduction of the heptavalent-conjugated pneumococcal vaccine. Pediatr Infect Dis J 2006;25:293-300. This was a retrospective case series of blood cultures obtained from previously healthy children aged three to 36 months taken in the outpatient clinic and emergency department (ED) setting over a five-year period (1998 to 2003) during the postpneumococcal vaccine era. Of 1077 unique blood cultures, 656 were identified as contaminants and 352 were positive for pathogenic bacteria. The percentage of blood cultures positive for Streptococcus pneumoniae decreased from 79% to 34%, while those positive for Escherichia coli rose from 7% to 34%. The overall pathogenic bacteremia rate decreased from 1.62% to 0.71% over the same period. The contamination-pathogen ratio increased from 1.2:1 to 2.3:1. A white blood cell count greater than 15×109/L had a 74% sensitivity and a 55% specificity for pathogenic bacteria during the past two years of the study.
SEARCHING FOR AN EFFECTIVE ANTIEMETIC FOR CHILDREN WITH GASTROENTERITIS Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. New Engl J Med 2006;354:1698-705. This was a prospective, randomized trial of oral ondansetron versus placebo given to children six months to 10 years of age with gastroenteritis and mild to moderate dehydration on arrival in the ED. The primary outcome was the proportion of children who vomited in the first hour of treatment with oral rehydration. The ondansetron group vomited 14% of the time versus 35% of the children in the placebo group, P
