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Master Thesis

Adhésion aux recommandations de l’ESPGHAN 2014 dans la prise en charge thérapeutique ambulatoire et hospitalière des gastro-entérites aiguës de l’enfant au CH d’Arcachon

Abstract : Introduction: acute gastroenteritis is a commom condition, often considered trivial by parents and healthcare professionals. However, it represents a considerable health and economic burden due to the medical consumption it generates and its indirect costs, which are still poorly assessed to date. The diagnosis is clinical and requires careful examination to assess the degree of dehydration guiding outpatient or inpatient management. Its treatment was the subject of recommendations from various expert committees including the nutrition committee of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) in 2014. The use of oral rehydration fluids (ORS) associated to an early refeeding have a preponderant place while that of adjuvant drugs is only very limited. In this context, we wanted to analyze professional practices on clinical evaluation and outpatient and inpatient management of acute gastroenteritis (AGE) in children in relation to the recommendations of ESPGHAN 2014. Methods: we carried out a survey of pratices on a population who consulted in the Emergency Department of the Arcachon Hospital Center from January 1 2020 to February 28 2020. This was a descriptive, cross-sectional and single-center retrospective data analysis. Results: ruring the analysis period, after the application of the exclusion criteria, 53 children were eligible during the period considered. Of these children, 75,5% were not clinically dehydrated and 77,4% had received outpatient care. No child had moderate or severe dehydration. Regarding outpatient care provided in the Emergency Department, only 37,7% of them complied overall with the recommendations. In fact, 39% of the children presenting with diarrhea and/or vomiting had not received any hydration during their treatment on the grounds that they were not clinically dehydrated at the time of the examination. On the other hand, 83,3% of hospital treatments were globally compliant. In addition, the study showed that the prescription of ORS was not systematic in the face of digestive disorders, so much so that at least one symptomatic treatment was more frequent. Only 54,7% of doctors’ prescriptions included ORS but 56,6% of adjuvant treatments. Conclusion: a minority of physicians seem to follow the guidelines of ESPGHAN 2014 for optimal management of children with AGE. Indeed, although the most common recommendation followed is the use of ORS to treat dehydration, it is insufficient as a preventive measure in children who are not dehydrated. On the other hand, the overuse of symptomatic treatments, contrary to recommendations, is worrying. Thus, an improvement in our practices should be considered by strengthening parental knowledge and their therapeutic education regarding the preventive and early administration of ORS at home as soon as digestive symptoms appear and by limiting the co-prescription of symptomatic treatments. This improvement appears capital for the reduction in the number of emergency room consultations or hospitalizations, as well as for the reduction in the financial costs that they generate. It is just as crucial in limiting the morbidity and mortality of a pathology which in the vast majority of cases remains easy to control.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03377894
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Submitted on : Thursday, October 14, 2021 - 12:46:18 PM
Last modification on : Wednesday, November 24, 2021 - 3:16:18 AM

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Victoria Lefebvre. Adhésion aux recommandations de l’ESPGHAN 2014 dans la prise en charge thérapeutique ambulatoire et hospitalière des gastro-entérites aiguës de l’enfant au CH d’Arcachon. Médecine humaine et pathologie. 2021. ⟨dumas-03377894⟩

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