• Stephen B Freedman, Laura E Keating, Maggie Rumatir, and Suzanne Schuh.
• Divisions of aPediatric Emergency Medicine, Hospital for Sick Children Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. stephen.freedman@albertahealthservices.ca
• Pediatrics. 2012 Dec 1; 130 (6): e1504-11.

ObjectiveDespite evidence supporting its use, nasogastric rehydration is rarely used in North America. We conducted a prospective, cross-sectional, 3-phase study to evaluate current perspectives.MethodsWe compared the proportions of respondents in favor of nasogastric (as opposed to intravenous) rehydration, should oral rehydration fail, between clinicians and caregivers. Phase 1: caregivers of children aged 3 to 48 months, who presented to a Canadian pediatric emergency department with symptoms of gastroenteritis, were invited to complete a survey. Phase 2: phase 1 participants administered intravenous or nasogastric rehydration had the procedure observed and outcome data recorded. Phase 3: pediatric emergency medicine physicians, fellows, and nurses completed a survey.ResultsFour hundred thirty-five children-parent dyads and 113 health care providers participated. If oral rehydration were to fail, 10% (47 of 435) of caregivers and 14% (16 of 113) of clinicians would choose nasogastric rehydration (difference = 3.4%; 95% confidence interval: -2.8 to 11.4). Caregivers were more familiar with the term intravenous than nasogastric rehydration (80% vs 20%; P < .001). Sixty-four children (15%) received intravenous rehydration; none received nasogastric rehydration. Participating nurses have inserted 90 (interquartile range: 25-150) intravenous cannulas compared with 4 (interquartile range: 2-10) nasogastric tubes during the preceding 6 months (P < .001). After a brief educational intervention, the proportion recommending nasogastric rehydration increased to 27% (117 of 435) among caregivers (P < .001) and 43% (49 of 113) among health care providers (P < .001).ConclusionsIn keeping with caregiver desires, health care providers in a Canadian emergency department employ intravenous rehydration when oral rehydration fails. Enhanced change management strategies will be required for nasogastric rehydration to become adopted in this environment.

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