Abstract
Between-country variation in health care resource use and its impact on outcomes in acute care settings have been challenging to disentangle from illness severity by using administrative data. We conducted a preplanned analysis employing patient-level emergency department (ED) data from children enrolled in 2 previously conducted clinical trials. Participants aged 3 to <48 months with><72 hours of gastroenteritis were recruited in pediatric eds in the united states (n="10" sites; 588 participants) and canada (n="6" sites; 827 participants). the primary outcome was an unscheduled health care provider visit within 7 days; the secondary outcomes were intravenous fluid administration and hospitalization at or within 7 days of the index visit. in adjusted analysis, unscheduled revisits within 7 days did not differ (adjusted odds ratio [aor]: 0.72; 95% confidence interval (ci): 0.50 to 1.02). at the index ed visit, although participants in canada were assessed as being more dehydrated, intravenous fluids were administered more frequently in the united states (aor: 4.6; 95% ci: 2.9 to 7.1). intravenous fluid administration rates did not differ after enrollment (aor: 1.4; 95% ci: 0.7 to 2.8; us cohort with canadian as referent). overall, intravenous rehydration was higher in the united states (aor: 3.8; 95% ci: 2.5 to 5.7). although hospitalization rates during the 7 days after enrollment (aor: 1.1; 95% ci: 0.4 to 2.6) did not differ, hospitalization at the index visit was more common in the united states (3.9% vs 2.3%; aor: 3.2; 95% ci: 1.6 to 6.8). among children with gastroenteritis and similar disease severity, revisit rates were similar in our 2 study cohorts, despite lower rates of intravenous rehydration and hospitalization in canadian-based eds.>
