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An analysis of persistent vomiting among children in emergency department (ED) presentations found that children under 2 years of age and those with 10 or more episodes of vomiting at presentation were more likely to benefit from ondansetron after discharge than other children. As published in JAMA Network Open, researchers analyzed 977 children with acute gastroenteritis–associated vomiting between September 14, 2019, and June 27, 2024, and found that overall, 8.6% of children had 3 or more episodes of vomiting in the 24 hours after ED discharge. Children aged 6 months–2 years were at greatest risk, especially those who initially presented with significant vomiting (at least 10 vomiting episodes in the 24 hours before presentation). Children who experienced 3 or more vomiting episodes after the ED visit—compared to those who did not —were significantly more likely to require additional care, including additional unscheduled healthcare revisits (41.3% vs 7.7%), intravenous fluids (11.3% vs 1.8%), and hospitalization (6.2% vs 1.1%) within 7 days. The unscheduled revisits included 73 (7.5%) patients going back to the ED; 25 (2.6%) going to a primary care physician; and 11 (1.1%) going to a walk-in care provider.
Targeted use of ondansetron: The authors note that ondansetron prescriptions at ED discharge “have become ubiquitous” in the United States for kids’ vomiting but caution that ondansetron has the potential for side effects, including diarrhea. They conclude that targeted home ondansetron use may be most beneficial for younger children and those with severe early illness—rather than routine prescribing for all patients, given that such a large percentage of kids didn’t experience vomiting after they went home.