From the Guidelines
The decision to admit an adult patient with gastroenteritis should be based on the presence of 'complicated' factors such as sepsis, neutropaenia, bleeding, dehydration, or severe symptoms, rather than a specific gastroenteritis score. When evaluating the need for hospital admission, factors such as the patient's ability to maintain hydration, presence of severe electrolyte abnormalities, significant comorbidities, or hemodynamic instability should be considered 1. In cases where patients present with severe symptoms or 'complicated' factors, hospital admission is usually necessary for intensive management, which may include intravenous fluids, octreotide, and antibiotics 1. Key considerations for admission include:
- Presence of sepsis or neutropaenia
- Severe dehydration or bleeding
- Significant comorbidities
- Hemodynamic instability
- Inability to maintain hydration
- Severe electrolyte abnormalities The management of these patients should involve a comprehensive evaluation, including complete blood count, electrolyte profile, and a stool work-up to identify potential causes of gastroenteritis 1. It is essential to consider the patient's social circumstances and ability to manage at home when making admission decisions.
From the Research
Gastroenteritis Score for Admission
The decision to admit a patient with gastroenteritis is often based on the severity of their symptoms and the risk of dehydration. Several studies have investigated the factors that influence admission decisions and the effectiveness of different treatments in reducing the need for hospitalization.
- A study published in 2013 2 found that the need for intravenous rehydration is the main cause of hospital admission for children with acute gastroenteritis, but a standardized rehydration scheme is not available.
- Another study published in 2022 3 found that the use of ondansetron can decrease the need for intravenous fluids and reduce hospitalizations in pediatric patients with acute gastroenteritis.
- A systematic review and meta-analysis published in 2008 4 found that ondansetron therapy decreases the risk of persistent vomiting, the use of intravenous fluid, and hospital admissions in children with vomiting due to gastroenteritis.
Factors Influencing Admission Decisions
Several factors can influence the decision to admit a patient with gastroenteritis, including:
Severity of symptoms, such as dehydration and vomiting
Age and underlying health status of the patient
Availability of supportive care at home
Access to oral rehydration therapy and other treatments
A study published in 1990 5 found that admissions for gastroenteritis were predominantly from socially disadvantaged families, and that suboptimal treatment was common.
A review article published in 2012 6 found that the treatment of gastroenteritis in children focuses on preventing dehydration, and that oral rehydration therapy and ondansetron can be effective in reducing the need for hospitalization.
Treatment Options
Several treatment options are available for patients with gastroenteritis, including:
Oral rehydration therapy
Ondansetron and other antiemetic agents
Probiotics
Supportive care, such as rest and hydration
The study published in 2013 2 found that rehydration therapy through nasogastric tube is better than intravenous rehydration in children with moderate-severe dehydration.
The review article published in 2012 6 found that probiotics can be used to shorten the course of diarrhea, and that good handwashing can reduce the incidence of acute gastroenteritis.