Scenario

You are a paediatric specialist registrar in a busy accident and emergency (A&E) department, and the A&E senior house officer refers to you a 3-year-old girl with a clinical diagnosis of viral gastroenteritis who has failed an oral fluid challenge (OFC). She is alert but miserable with 1–2% dehydration and is keen to drink but vomits after most fluid intake. You explain to her mother that she may need admission for nasogastric or intravenous fluids, but her mother responds by asking why you don't use medication to stop the vomiting. You wonder whether ondansetron with its relatively good side-effect profile in children might avoid this child having to be admitted and given intravenous fluids.

Structured clinical question

In children presenting with vomiting secondary to gastroenteritis [patient], does oral ondansetron [intervention] reduce vomiting, the need for intravenous fluids or admission to hospital [outcome]?

Search strategy and outcome

A primary search of Medline was conducted via PubMed using the search terms: (ondansetron or antiemetics) and (vomiting or gastroenteritis). Limits were: child <18 years, human and English language. A total of 1329 articles were found, nine of which were relevant.

A secondary search via the NHS Evidence National …