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					                        ALBERTA RESEARCH CENTRE FOR CHILD HEALTH EVIDENCE




                                     Data Extraction Form

             Oral rehydration versus intravenous therapy for treating dehydration
                            due to gastroenteritis in children 2001

ID Ref:                                                         Reviewer:

Patient Allocation:     Inpatient:      Outpatient:      (Includes Emergency Hospital Unit)

                                        Study Characteristics
Language of publication
Year of publication/ending
Country of origin
Sponsored by
Jadad scale (1-5)
Intention to treat analysis Y/N
Allocation concealment: adequate (1),
inadequate (2), or unclear (3)
Definition of Diarrhea                          Definition of dehydration


Definition of success                           Definition of failure

Inclusion criteria                              Exclusion criteria


Comments


                             Patient Characteristics at Entry (Baseline)
Total sample size                 IV Solution       IV Solution    ORT solution   ORT solution
N=                                     1                 2               1             2
Number of randomized
patients
Withdrawals reasons
(n,%)

Age (mean)     <13 mths
               13-60 mths
               >60 mths
               All ages
Gender (n)     Males
               Females
Baseline       Mild
dehydration    Mod
               Severe
History of vomiting
Clinical antecedents
                         ALBERTA RESEARCH CENTRE FOR CHILD HEALTH EVIDENCE




                                            Interventions
                                  IV Solution        IV Solution    ORT solution   ORT solution
                                       1                  2            1                2

Charac. Of     [Na]
Solution       [Cl]
used           [K]
               [gluc]
               Osm
               Other
Rate and protocol of
rehydration (cc/kg/hr)




Route (IV/NG/PO)                      IV                 IV
IV
Breastfeeding or feeding
allowed? How?



Comments
                       ALBERTA RESEARCH CENTRE FOR CHILD HEALTH EVIDENCE



                                            Outcome
                                 IV Solution     IV Solution      ORT solution   ORT solution
                                      1               2              1                2
Time to           Hours in ER
rehydration       Admits from
   (mean)         ER (n,%)
                  Days on
                  ward
Total duration of therapy

Duration of      At admission
diarrhea         At t =____

Volume of        At admission
stools           At t =____

Frequency of     At admission
Stools           At t =____

Weight gain   At admission
              At time =___
                      =___
              % change
Complications    HyperNa+
  (n, %)         Hypo Na+


Side effects
   (n, %)



Failures
(n.%)


Na+      entry
        Time
        =__
        Time
        =__
        Time
        =__
        Total
        intake
Total fluid
intake
Deaths (n,%)
(Cause)
                       ALBERTA RESEARCH CENTRE FOR CHILD HEALTH EVIDENCE




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