Predictors of Hospital Admissions and Return Visits in Children with Suspected Dehydration Presenting to the Emergency Department.

BACKGROUND

Dehydration is a primary cause of visits to pediatric emergency departments (PED).

OBJECTIVES

1) To identify predictors of hospital admission and return visits (RV) in PED patients with all-cause dehydration. 2) To explore the association between dehydration and serum bicarbonate (HCO3) levels.

METHODS

This single-center prospective cohort study included patients under 18 years with dehydration from any cause, presenting to the PED of a tertiary center from November 2018 to March 2020. The primary outcome was hospital admission; the secondary outcome was RV to the PED. HCO3 was measured for all visits. Bivariate and multivariate analyses were conducted.

RESULTS

The study included 324 patients: most with mild dehydration (199/324, 61%). Of these, 74 (22.8%) were admitted, while 250 (77%) were discharged, 25 of which (10.8%) returned to the PED. Predictors of hospital admission included physician-estimated dehydration >5% (adjusted odds ratio [aOR] = 2.9; 95% CI: 1.5-5.8), ≥1 intravenous (IV) fluid bolus (aOR = 5.4; 95% CI: 1.2-23.8), antibiotics (aOR = 11.92; 95% CI: 3.4-35.5), and HCO3 ≤16 mmol/L (aOR = 4.4; 95% CI: 1.3-14.7). Admitted patients had lower mean HCO3 levels (19.94 ± 3.38 mmol/L vs. 20.98 ± 2.65 mmol/L, p = 0.017). Dry mucous membranes at the index visit were the only significant predictor of RV (12% vs. 35.5%, p = 0.023). Antipyretics/analgesics were associated with RV (76% vs. 51.9%, p = 0.03). Gastritis was inversely associated (4.0% vs. 22.3%, p = 0.03) with RV, but these were nonsignificant in multivariate analysis.

CONCLUSION

In this PED cohort, we found no predictors for RV to the PED. However, HCO3 ≤16 mmol/L, physician-estimated dehydration >5%, ≥1 IV fluid bolus, and PED antibiotics were associated with increase hospital admission. If replicated, these findings can help clinicians make faster disposition decisions when caring for dehydrated pediatric patients.