Evidence map›Paper›PMID 29426307›Full record

SynthesisBMC pediatrics2018

Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis.

M A Iro, T Sell, N Brown, K Maitland

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC pediatrics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
2.5field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Review
  5. Review
  6. Review
  7. [Paediatric Life Support].Notfall & rettungsmedizin · 2021
    Review
  8. Article
  9. Acute Infectious Gastroenteritis in Infancy and Childhood.Deutsches Arzteblatt international · 2020
    Review
  10. Acute Infectious Diarrhea and Gastroenteritis in Children.Current infectious disease reports · 2020
    Review
  11. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 3 countries.

M A IroOxford Vaccine Group, Department of Paediatrics and the NIHR Biomedical Research Centre, University of Oxford, Headington, Oxford, OX3 7LE, UK.
T SellOxford Vaccine Group, Department of Paediatrics and the NIHR Biomedical Research Centre, University of Oxford, Headington, Oxford, OX3 7LE, UK.
N BrownDepartment of Paediatrics, Salisbury District Hospital, Salisbury, SP2 8BJ, UK.
K MaitlandDepartment of Paediatrics, Faculty of Medicine, Wellcome Trust Centre for Clinical Tropical Medicine, Imperial College, W2 1PG, London, UK. K.maitland@imperial.ac.uk.ORCID 0000-0002-0007-0645
University of Oxford · GBAga Khan University · PKKenya Medical Research Institute · KE

Funding

Medical Research Council G0801439Medical Research Council MR/R018502/1
6 · The paper itself

Abstract

backgroundThe World Health Organization (WHO) recommends rapid intravenous rehydration, using fluid volumes of 70-100mls/kg over 3-6 h, with some of the initial volume given rapidly as initial fluid boluses to treat hypovolaemic shock for children with acute gastroenteritis (AGE) and severe dehydration. The evidence supporting the safety and efficacy of rapid versus slower rehydration remains uncertain.

methodsWe conducted a systematic review of randomised controlled trials (RCTs) on 11th of May 2017 comparing different rates of intravenous fluid therapy in children with AGE and moderate or severe dehydration, using standard search terms. Two authors independently assessed trial quality and extracted data. Non-RCTs and non-English articles were excluded. The primary endpoint was mortality and secondary endpoints included adverse events (safety) and treatment efficacy. MAIN

resultsOf the 1390 studies initially identified, 18 were assessed for eligibility. Of these, 3 studies (n = 464) fulfilled a priori criteria for inclusion; most studied children with moderate dehydration and none were conducted in resource-poor settings. Volumes and rates of fluid replacement varied from 20 to 60 ml/kg given over 1-2 h (fast) versus 2-4 h (slow). There was substantial heterogeneity in methodology between the studies with only one adjudicated to be of high quality. There were no deaths in any study. Safety endpoints only identified oedema (n = 6) and dysnatraemia (n = 2). Pooled analysis showed no significant difference between the rapid and slow intravenous rehydration groups for the proportion of treatment failures (N = 468): pooled RR 1.30 (95% CI: 0.87, 1.93) and the readmission rates (N = 439): pooled RR 1.39 (95% CI: 0.68, 2.85).

conclusionsDespite wide implementation of WHO Plan C guideline for severe AGE, we found no clinical evaluation in resource-limited settings, and only limited evaluation of the rate and volume of rehydration in other parts of the world. Recent concerns over aggressive fluid expansion warrants further research to inform guidelines on rates of intravenous rehydration therapy for severe AGE.

Indexed as

Acute DiseaseAdolescentChildChild, PreschoolDehydrationFluid TherapyGastroenteritisHumansInfantInfant, NewbornInfusions, IntravenousRandomized Controlled Trials as TopicRiskTime FactorsTreatment OutcomeAcute gastroenteritisAfricaAsiaDehydrationEmergency careIntravenous rehydrationSystematic review

Identifiers

PMID29426307
PMCPMC5807758
OpenAlexW2794964386

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.