Emergency Medicine Research Review has recently published the following two reviews which you will find of interest regarding Children who are attended to in the Emergency Department The two studies are the Effect of intravenous ondansetron on QTc interval in children with gastroenteritis and  Behavioral changes in children after emergency department procedural sedation.

Effect of intravenous ondansetron on QTc interval in children with gastroenteritis Authors: Hoffman RJ and Alansari K

Summary:This prospective analysis sought to establish the effects of IV ondansetron (0.15 mg/kg) on QT interval in children presenting to ED with gastroenteritis-associated vomiting. Subjects were 134 children aged < 14 years, 46% male. ECGs were taken before, and at 15, 30, 45 and 60 minutes after receipt of ondansetron.

Following manual measurement of QT interval, QTc (corrected QT interval) was calculated using both Bazett’s (QTcB) and Fridericia’s (QTcF) formulas. Average baseline measures were QTcB 415 msec (95% CI; 343, 565) and QTcF 373 msec (304, 499). Following ondansetron administration, mean difference in QTc was 0.4 msec for QTcB (−35, 45 msec) and 0.1 msec for QTcF (−40, 18 msec).

 The authors concluded that IV ondansetron at 0.15 mg/kg was not associated with QT prolongation among children treated for gastroenteritis-associated vomiting.

 Comment:This is a concise and well conducted study in a paediatric cohort. Prolonged QTc has been implicated in fatal dysrhythmias. The data collection and analysis was appropriate and valid. Results indicate IV ondansetron is safe in this cohort. This has major implications for children presenting to EDs with vomiting and requiring intravenous therapy.

Reference: Am J Emerg Med. 2018;36(5):754-757 Abstract

Behavioral changes in children after emergency department procedural sedation Authors: Pearce JI et al.

Summary:This prospective cohort study examined the impact of procedural sedation with IV ketamine in children on negative, post-discharge behaviours. 97 children undergoing procedural sedation with IV ketamine for fracture reduction in the ED were included in the analysis. Pre-procedural anxiety (Modified Yale Preoperative Anxiety Scale) was high in 40% of participants. At 1 to 2 weeks post-discharge from ED, negative behavioural changes (Post-Hospitalization Behavior Questionnaire) had occurred in 22% of participants. Under multivariable logistic regression analysis factors predicting negative behaviours were high anxiety OR 9.0 (95% CI; 2.3, 35.7) and non-white race (OR 6.5; 1.7, 25.0).

Comment: This is a useful and concise study evaluating pre-procedural anxiety and post-procedural behaviour disturbance following the use of IV ketamine in a North American setting. The study methodology, data collection and analysis was appropriate and well done, even though the sample was small. The conclusions were valid. The survey questionnaires were previously validated.

Of interest were the findings that pre-procedural anxiety and non-white race were predictors of post behavioural disturbances which could last up to 2 weeks. It would also indicate that pre-procedural anxiety screening should be used routinely, and anxiolytic therapy be used in highly anxious children. It would also be interesting to see if the same findings are applicable to the Australasian setting.

Reference: Acad Emerg Med. 2018;25(3):267-274 Abstract

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