Oral versus intravenous: Rehydration preferences of pediatric emergency medicine fellowship directors

Objective: The American Academy of Pediatrics (AAP) recommends oral rehydra tion therapy (ORT) for management of uncomplicated childhood gastroenteriti s with mild-moderate dehydration. However, ORT is widely underused relative to their recommendations. We compared ORT use by directors of Pediatric Em ergency Medicine (PEM) fellowship training programs with AAP recommendation s, and sought to identify their barriers to ORT. Methods: Mail/fax survey of the directors of U.S. and Canadian PEM fellowsh ip programs. The survey included 10 scenarios of mild or moderately dehydra ted children with gastroenteritis, a personal innovativeness scale, self-as sessment of ORT experience and knowledge, and open-ended questions regardin g perceived barriers to ORT use. Results: 60/67 (89.6%) PEM fellowship program directors responded. All repo rted experience with and knowledge about ORT. Only 10/58 (17.2%) believe OR T is usually better than intravenous (TV) rehydration in all 10 clinical sc enarios, and only 4/58 (6.7%) usually use ORT in all 10 scenarios. 18/58 (3 1%) usually use ORT for all mildly but no moderately dehydrated children. O RT use did not correlate with personal innovativeness scores. Important bar riers cited by respondents include additional time requirements for ORT rel ative to IV rehydration (76.7%) and expectation of TV rehydration by parent s (41.7%) or primary care physicians (10%). Conclusions: Relative to AAP recommendations, PEM fellowship directors unde ruse ORT, especially for moderately dehydrated children. Physician innovati veness does not influence ORT use. Further study of effectiveness, length o f stay, staff requirements, and ORT acceptance in the emergency department setting, especially in children with moderate dehydration, may influence OR T use.