treatment of acute gastroenteritis focus primarily on the correction of dehydrationand electrolyte abnormalities. So oral rehydration is the recommended therapy inmild to moderate dehydration secondary to acute gastroenteritis and has been provensafe and cost-effective, but it remains widely underused. Indeed, pediatric emergencyphysicians are more likely to choose intravenous over oral rehydration when the childvomits repeatedly. It has been estimated that oral rehydration is used in under 30% ofcases of diarrhea in the US and some physicians prescribed antiemetics for treatmentof children with vomiting from acute gastroenteritis. However, antiemetics use foracute gastroenteritis has not been well studied, and its use is controversial. Thus, weconducted a study to investigate potential beneficial effects of ondansetron versusplacebo, in treating vomiting during acute gastroenteritis in children.

Methods: A randomized, double blind, placebo-controlled trial was performed in anuniversity and a government hospital ED. Children, 5 months to 8 years, vomiting � 4times during the preceding 24 hours, mild/moderate dehydration were randomized toreceive either oral disintegrating ondansetron tablets and placebo. Oral fluid tolerance, IVrehydration requirement, and hospitalization were evaluated at 8 and 36 hours. Thosetolerating oral rehydration therapy and not vomiting were discharged. Discharged patientswere evaluated by telephone at 24 hours to record vomiting, diarrhea and revisits. Theprimary outcome measure was the frequency of emesis during the 8 hour period afterenrollment. The secondary outcomes are the rates of intravenous fluid administration oradmission to hospital, and frequency of diarrhea.

Results: One hundred and nine patients were enrolled; 54 received placebo and55 received ondansetron. At baseline, age distribution, sex, frequency of emesis anddiarrhea did not differ between both study groups. The ranks sum of vomitingepisodes were significantly lower in the ondansetron group as compared with placebogroup (��0.001) at both the 8- and 36-hour follow-up. During the first 8 hours,there was no statistically significant difference in the rank sum of episodes of diarrheabetween the groups (��0.619); however, during the next 24 hours follow-up, it wassignificantly lower in the placebo group (��0.04). As compared with children whoreceived placebo, children who received ondansetron were less likely to vomit bothduring the first 8 hour in the ED [relative risk (RR): 0.33, 95% confidence interval(CI): 0.19-0.56, number needed to treat (NNT): 2, 95% CI: 1.6-3.5], and during thenext 24 hours follow-up (RR: 0.015, 95% CI: 0.07-0.33, NNT: 2, 95% CI: 1.3-2.1).The rate of admission (RR: 0.29, 95% CI: 0.009-1.01, NNT: 8, 95% CI: 4.9-91.7,��0.07) and of return visits to the ED (RR: 0.91, 95% CI: 0.33-2.5, NNT: 2, 95%CI: 1.3-2.1, ��0.91) did not differ significantly between groups.

Conclusion: Ondansetron may be an effective and efficient treatment thatreduces the incidence of vomiting from gastroenteritis during both the first 8 hoursand the next 24 hours, and is probably a useful adjunct to oral rehydration.

40 The Use of a Handheld Bladder Ultrasound Scanner inthe Assessment of Dehydration and MonitoringResponse to Therapy in a Pediatric EmergencyDepartment

Enright K, Beattie TF, Taheri S/Royal Hospital for Sick Children, Edinburgh,United Kingdom

Study Objectives:1) To investigate and characterize the utility of a handheld bladder ultrasound

scanner in the assessment of children with suspected dehydration.2) To clarify its potential role in monitoring response to therapy in the

emergency department and facilitating safe discharge.

Methods: Dehydration is a common concern for both parents and clinicians inpaediatric emergency care and oliguria is an early physiological response todehydration. There are few, if any, non-invasive, objective tools to aid the emergencyphysician in the assessment and management of dehydration. We conducted a pilotstudy on a convenience sample of patients attending the emergency department at apaediatric teaching hospital with a clinical presentation consistent with dehydration.Patients were recruited whenever the principal investigator was present in theemergency department. In addition to history and physical examination, a studyproforma was completed detailing features of possible dehydration (including theWorld Health Organization guide to dehydration assessment). All patients had serialbladder ultrasounds performed by the emergency physician at half-hourly to hourlyintervals but were treated independently of the results, which were analyzed followingpatient discharge. The handheld ultrasound device was used according to themanufacturer’s guidelines.

Results: Forty-five patients aged between 4 months and 10 years with a median age of2 years (interquartile range of 1,4) were enrolled from May to July 2007. Twenty-seven

(60%) were male. There were 8 patients (17%) aged under one year. Using WHO criteria33 (73%), 8 (18%) & 4 (9%) were classified as having mild, moderate or severedehydration respectively. There was a statistically significant difference in urineproduction between children with mild versus moderate or severe dehydration (2.3 �/�1.5 mls/kg/hr vs 0.6 �/� 0.7 mls/kg/hr, p� 0.001). Eleven (24%) were admitted. Of the12 patients (26%) moderately or severly dehydrated, seven (58%) required admission, all(100%) of whom had documented impaired urine output (an average of 0.6ml/kg/hr).Response to fluid boluses, fluid challenges and oral rehydration programs were objectivelydemonstrated. In addition, 4 patients (9%) with features of possible dehydration but whoappeared to be drinking well, had in fact, impaired urine production (mean of 0.42ml/kg/hr) and this was also demonstrated by use of the handheld bladder scanner while in theemergency department.

Conclusions:1) Dehydration is a common presentation to the paediatric emergency

department and yet standard clinical parameters correlate poorly with objectivefeatures of the condition.

2) Use of the handheld bladder scanner offers a convenient, non-invasive andobjective adjunct to the assessment of dehydration and response to therapy inthese children.

41 Normal Renal Ultrasound Predicts Low Risk of UrologicIntervention for Emergency Department Patients WithSuspected Renal Colic

Sedran RJ, Yan JW, McLeod SL, Theakston KD, Edmonds ML/London HealthSciences Centre, London, Ontario, Canada

Background: Renal colic is a common emergency department (ED) diagnosis.Computed tomography (CT) is a frequently employed imaging modality for patients withsuspected renal colic because of its high diagnostic accuracy. However, there is increasingconcern about the lifetime cumulative radiation exposure attributed to CT. This is ofparticular concern for younger patients with a recurrent, non-life threatening disease suchas renal colic. Ultrasound (US) is a widely available, low cost imaging modality that mayalso be used to diagnose renal colic without exposing the patient to radiation.

Study Objectives: The objective of this study was to determine the ability of USto identify renal colic patients with a low risk of requiring urologic interventionwithin 90 days of their initial ED visit.

Methods: A retrospective chart review was completed for all adult patients whohad an ED-ordered US for suspected renal colic. Data was gathered from two tertiarycare EDs with a combined annual census of 95,000 during a one-year period (January1 to December 31, 2006). Independent, double data extraction was performed for allimaging reports and results were categorized as normal, suggestive, stone seen or non-renal disease. The charts of all patients with a normal US were reviewed to determineif they required any urologic intervention within 90 days after their initial ED visit.

Results: There were 857 ED-ordered renal ultrasounds during the study period.The study patients had a mean age of 44 years (range 18-95 years) and 53% weremale. Of the 857 renal ultrasounds ordered during the study period, 373 (43.5%)were classified as normal. Of these, 49 (13%) underwent additional imagingidentifying 6 (1.6%) stones, only two (� 1%) of which required urologicintervention with lithotripsy.

Conclusions: A normal renal US predicts a low likelihood for urologicintervention within 90 days for adult emergency department patients with suspectedrenal colic. The use of US may avoid the risks of radiation for many patients withsuspected renal colic without adversely affecting their clinical outcomes. Furtherprospective research is needed to better define the role of ultrasound in the emergencymanagement of renal colic.

42 Abstract Withdrawn

43 Development and Validation of a CaregiverGastroenteritis Knowledge Questionnaire

Freedman SB, Deiratany S, Goldman R, Benseler S/Hospital for Sick Children,Toronto, Ontario, Canada; BC Children’s Hospital and the Child & FamilyResearch Institute, Vancouver, British Columbia, Canada

Study Objectives: Since caregiver knowledge deficiencies are associated with thedevelopment of dehydration and nonurgent emergency department visits, we sought

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to develop and describe the reliability and validity of a Caregiver GastroenteritisKnowledge Questionnaire.

Methods: The questionnaire consists of 38 true/false questions covering signs ofdehydration, indications to see a physician, oral rehydration therapy, solid intake andrefeeding, medication use and disease transmission. Following validation procedures,80 caregivers of children with gastroenteritis, 25 nurses and 22 pediatric emergencymedicine physicians completed the questionnaire. One month later, participantscompleted the questionnaire a second time.

Results: Content validity was confirmed qualitatively. Construct validity wasdemonstrated by incremental increases (P � 0.001) in mean total scores fromcaregivers to nurses to physicians. Multiple regression analysis revealed the number ofprior visits for gastroenteritis was inversely associated with overall caregiver score (P �

0.02). Internal test-retest data gave a single measure intraclass correlation coefficientof 0.74 (95% Confidence Interval: 0.62, 0.83) and domain coefficients � 0.50 for alldomains except “signs of dehydration.” The Pearson correlation coefficient for thetest-retest score was 0.75. Internal consistency was demonstrated with a Cronbach’salpha of 0.67 at time 0 and 0.80 at time 1 month.

Conclusion: The Caregiver Gastroenteritis Knowledge Questionnaire is a reliable,valid instrument suitable for identifying knowledge gaps and measuring improvementfollowing educational interventions. Future uses may focus on individual knowledgedeficits or serve to document larger community educational needs.

44 Foreign Body Ingestion in Children

Chang YJ/Chang Gung Memorial Hospital, Taoyuan, Taiwan

Background: Foreign body ingestion is a common problem in pediatricemergency. The nature of the foreign body, the presentation, and the managementmay differ from those of the adult population. The study attempts to review theclinical presentation and the management of foreign body ingestion in children.

Study Design: The retrospective study that evaluated foreign body ingestion in apediatric department was conducted from January 2001 to September 2007 at asingle tertiary referral center.

Methods: Selection of Participants: Children under 18 years of age who hadforeign body ingestion identified via International Classification of Disease, ninthrevision code 938. Demographic data, the site and nature of foreign body, clinicalpresentation, radiographic finding, and endoscopic management were abstracted fromthe chart by using a standardized data collection sheet. The patients in our analysishad the following inclusion criterion: foreign bodies ingestion with radiographical orendoscopical proof or witnessed by family. Exclusion criteria: patients had incompletemedical records.

Results: A total of 212 records of children with suspected foreign body werereviewed. There were 127 boys and 85 girls. The mean age was 4.52�3.58 years(range, 7 months to 17 year). The ingestion of foreign body was witnessed by familyor the child gave the history of ingestion in 97% of cases. There was 3% no historysuggestive of ingestion in the remaining case. Eighty-three percent of the admittedchildren had radiographically proven foreign body, 49 % of them located inesophagus, 44% in the stomach, and 7% in the intestine. The most common type offoreign bodies, proven radiographically or endoscopically, were coin (29%), discbattery (20%), and sharp metallic objects (9%). The type of sharp metallic objects is6 screw, 5 dental reamer, 4 needle, 3 pins and 2 safety pins. Fifty-seven percentchildren with foreign body ingestion present asymptomatically. The main presentingsymptoms were vomiting (21%), drooling (15%), anorexia (7%), and cough (5%).Endoscopic removal was attempted in and foreign body was extracted successfully in23% of patients with disc battery or sharp metallic objects. Surgical procedure wasperformed in one patient with coin impacted in duodenum with failure of endoscopicremoval. The complication of foreign body ingestion was 1 gastrointestinal bleedingby dental reamer, and 2 esophageal stenosis with disc battery. No mortality or bowelperforation was noted.

Conclusion: Ingestion of foreign body is a common clinical problem in children.It should not be ignored in children with unexplained vomiting, anorexia, drooling orcough. Most children have a benign course and will spontaneously evacuate theforeign body. Removal of metallic sharp objects or disc battery may be safer, butcareful follow-up is sufficient if they have passed into the intestine. There is noindication for prophylactic laparotomy to retrieve foreign body.

45 Vulnerable Adolescents in the Emergency Department:Are We Providing Optimal Care?

Browning J, Khadr S, Cassidy J, Wilson B, Henderson A, Dunhill Z, Oglesby AJ/Edinburgh Royal Infirmary, Edinburgh, United Kingdom; Royal Hospital for SickChildren, Edinburgh, United Kingdom

Background: The RCPCH 2003 document “Bridging The Gaps: Health care foradolescents” reports that increasing numbers of adolescents are accessing emergencydepartments for overdose (OD), deliberate self-harm (DSH) and substance misuse (SM)with concerns that they do not receive optimal care. The emergency department (ED) atthe Royal Infirmary of Edinburgh (RIE), a large urban teaching hospital, sees adultpatients aged 13 years or over.

Study Objective: We examined the presentation and management of children lessthan (�) 16 years presenting to the RIE ED with OD, DSH and SM.

Methods: Retrospective study of all children �16 years of age who presented to theRIE ED between August 2004 and July 2005 with a diagnosis of OD, DSH or SM.Hospital notes and the ED computer system were interrogated and data was collected andanalysed.

Results: Over a 1 year period, 207 children presented, 56% with SM, 38% withOD and 6% with DSH.

Substance Misuse: 117 adolescents presented; 56% were female. 70% presented byEmergency Ambulance, 24% self-presented and 6% in police care. 2% were triagedcategory 1&2, 84% triage 3 and 14% triage 4. 76% had consumed alcohol, 7% had takendrugs, the commonest being ecstasy, and 17% had taken both alcohol and drugs. 19%required IV fluids. 11% were admitted to the RIE, 4% were discharged to police custody,6% did not wait to be seen and 79% were discharged without any follow-up. Of thosedischarged 93% had a responsible adult documented. Social work was involved in 14%cases.

Overdose: 78 adolescents had taken an overdose. 91% were female. 58% selfpresented and 42% by Emergency Ambulance. 3% were triaged category 2, 81% triage 3and 16% triage 4. Most of the drugs ingested were available over the counter: 69%paracetamol, 40% NSAIDS. 21% had ingested prescription drugs: the commonest beingantibiotics (8%). 29% ingested more than 1 drug. 18% had also consumed alcohol &/orrecreational drugs.

Deliberate Self Harm: 12 adolescents presented: 58% had self-harmed, 42% werethreatening to. 58% were female. 42% self presented, 33% by Emergency Ambulance and25% in Police care. All those that were discharged home had a responsible adult present.

Conclusion: Children �16 years who attend the ED with OD, DSH and SMrepresent a vulnerable group of patients. This study has highlighted the extent of theproblem and the results should influence health promotion. Within our ED an educationprogramme has been instituted to improve basic knowledge of adolescent health. Aproforma is now completed for every child �16 years attending the RIE ED to encouragesafe treatment, discharge and appropriate follow up. Improved links with Child &Adolescent Mental Health and social work will ultimately improve quality of care.

46 Children’s Weight “Guesstimates”: Could We?

Gardner S, Haber R/Ormskirk District General Hospital, Ormskirk, UnitedKingdom; University of Liverpool, Liverpool, United Kingdom

Study Objectives: To assess whether staff “guesstimates” of children’s weights aresufficiently accurate to be used as an approximation of children’s weights in apediatric emergency department where the majority of children are routinelyweighed. Previous studies suggested that they were inaccurate. To compare these“guesstimates” with the current Advanced Paediatric Life Support (APLS) andLuscombe’s formula for weight estimation.

Methods: Medical and nursing staff at all levels of seniority were recruited toestimate the weight of children within the pediatric emergency setting by visualestimation alone. These estimates were recorded and then compared with the actualweight, with the “APLS” formula estimate and the Luscombe formula estimate. Thelevel of seniority, and sex of the staff taking part was recorded.

Results: The “APLS” formula underestimated children’s weights by 21%,clinician’s estimates underestimated by 7%. The graph of clinician estimates closelymirrored the actual weights which were non-linear in nature. “APLS” estimates werelinear in nature. Within the group of clinicians those with mid-level experience weremost accurate, underestimating by only 3.7%. Female staff averaged 4.8%underestimates compared to 10.7% for males. Luscombe’s formula [3(age) �7]though linear, underestimated weights by 3.1%.

Conclusion: In a department where weights of children are routinely measured, it

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