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DOI: 10.1542/peds.

2011-2945
; originally published online May 14, 2012; 2012;129;1050 Pediatrics
Serge Gouin, Thuy-Tien Vo, Michel Roy, Denis Lebel and Jocelyn Gravel
Randomized Controlled Trial
Oral Dimenhydrinate Versus Placebo in Children With Gastroenteritis: A

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Oral Dimenhydrinate Versus Placebo in Children With
Gastroenteritis: A Randomized Controlled Trial
WHATS KNOWN ON THIS SUBJECT: Dimenhydrinate, an
antihistaminic agent, is a widely used drug in Canada and Europe.
It limits stimulation of the vomiting center via the vestibular
system. Multiple studies have shown its effectiveness in the
treatment of vertigo and postoperative nausea and vomiting.
WHAT THIS STUDY ADDS: Dimenhydrinate, when given orally, did
not signicantly decrease the frequency of vomiting in children
with acute gastroenteritis compared with placebo. The reported
adverse effect proportions were similar for the dimenhydrinate
and placebo groups.
abstract
OBJECTIVE: To evaluate the efcacy and safety of oral dimenhydrinate
in the treatment of acute gastroenteritis.
METHODS: This was a randomized, double-blind, placebo-controlled
trial conducted in the emergency department of a pediatric university-
afliated center. Children 1 to 12 years old who presented to the
emergency department with at least 5 episodes of vomiting in the
previous 12 hours and diagnosed with acute gastroenteritis were
block-randomized to receive oral dimenhydrinate (1 mg/kg; maximum:
50 mg) every 6 hours for 4 doses or placebo for 4 doses. The primary
outcome measure was treatment failure as dened by the occurrence
of $2 episodes of vomiting in the 24 hours after administration of the
rst dose of the study medication.
RESULTS: During the study period, 209 patients met inclusion criteria,
but 50 refused to participate and 7 were missed. Eight participants were
lost to follow-up, and 144 were thus included in the primary analysis. Of
these patients, 74 were randomized to receive dimenhydrinate and 70
placebo. The proportions of patients showing failure of treatment
were similar for both treatment groups: dimenhydrinate, 31% (23 of
74); placebo, 29% (20 of 70) (difference: 0.02 [95% condence interval:
0.12 to 0.17]). There were no differences between the 2 groups in
rates of intravenous cathether insertion, mean number of episodes
of vomiting or diarrhea, abdominal pain, nausea, duration of symptoms,
revisit rates, or parental absenteeism. The proportions of adverse
effects were similar in both groups (53% vs 54%).
CONCLUSIONS: The prescription of oral dimenhydrinate did not signif-
icantly decrease the frequency of vomiting in children with acute gas-
troenteritis compared with placebo. Pediatrics 2012;129:10501055
AUTHORS: Serge Gouin, MDCM, FRCPC,
a
Thuy-Tien Vo, MD,
FRCPC,
a
Michel Roy, MD, FRCPC,
a
Denis Lebel, BPharm,
MSc,
b
and Jocelyn Gravel, MD, FRCPC, MSc (Epid)
a
a
Division of Emergency Medicine, Department of Pediatrics, and
b
Department of Pharmacy, Centre Hospitalier Universitaire
Sainte-Justine, Universit de Montral, Montreal, Quebec, Canada
KEY WORDS
antiemetic agent, children, gastroenteritis, vomiting
ABBREVIATIONS
CIcondence interval
EDemergency department
All authors have completed the following: (1) substantial
contributions to conception and design, acquisition of data, or
analysis and interpretation of data; (2) drafting the article or
revising it critically for important intellectual content; and (3)
providing nal approval of the version to be published.
This trial has been registered at www.clinicaltrials.gov
(identier NCT00124787).
www.pediatrics.org/cgi/doi/10.1542/peds.2011-2945
doi:10.1542/peds.2011-2945
Accepted for publication Feb 8, 2012
Address correspondence to Serge Gouin, MDCM, FRCPC, Division
of Emergency Medicine, Department of Pediatrics, CHU Sainte-
Justine, 3175 Cte-Sainte-Catherine, Montreal, Quebec, Canada,
H3T 1C5. E-mail: sergegouin@aol.com
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright 2012 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no nancial relationships relevant to this article to disclose.
FUNDING: This study was funded in part by a grant from the
Association des Mdecins dUrgence du Qubec and by a grant
from the Research Institute of CHU Sainte-Justine.
1050 GOUIN et al
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Acute gastroenteritis is one of the most
common pediatric problems world-
wide.
1
Vomiting is a common symptom
in children with infectious gastroenteri-
tis. The benet of oral rehydration with
a glucose electrolyte solution during
gastroenteritis is well recognized as the
mainstay treatment modality.
1
Although
it prevents dehydration, this measure
does not decrease unpleasant symp-
toms, such as nausea and vomiting, ex-
perienced by children.
1
Achieving control
of these symptoms could be benecial
not only for the patients comfort but
also because it could prevent further
dehydration by limiting uid loss and
facilitating oral rehydration. Dimenhy-
drinate, an over-the-counter, widely used
drug in Canada and Europe, is an etha-
nolamine derivative antihistamine.
2
It
limits stimulation of the vomiting center
by the vestibular system, which is rich in
histamine receptors.
1
Multiple studies
have shown dimenhydrinates effective-
ness in the treatment of postoperative
nausea and vomiting in children.
36
It is
also used for the treatment of vertigo in
children.
7
Furthermore, it is inexpensive
to administer, with an average cost of US
$0.30 per dose.
8
The principal adverse
effects of dimenhydrinate are drowsi-
ness, dizziness, and anticholinergic
symptoms.
9
Restlessness and insomnia
have also been described in children.
A previous study by Uhlig et al
9
evaluated
the efcacy and safety of dimenhydri-
nate in children with gastroenteritis.
They reported that dimenhydrinate ad-
ministration to children with none/mild
dehydration reduced the frequency of
vomiting. It did not, however, improve
oral rehydration or clinical outcomes.
Their decision to assess rectal admin-
istration may limit the generalizability
and validity of their ndings, particu-
larly to children with diarrhea.
To our knowledge, no data have been
published on the efcacy of oral di-
menhydrinate in controlling emesis in
children with acute gastroenteritis. We
hypothesized that the children treated
with oral dimenhydrinate during an
acute episode of gastroenteritis would
experience fewer episodes of vomiting
than children who received placebo.
The objective of our study was to
evaluate the efcacy and safety of oral
dimenhydrinate in the treatment of
vomiting due to acute gastroenteritis
in children.
METHODS
We conducted a randomized, double-
blind, placebo-controlled clinical trial
in a pediatric university-afliated hos-
pital emergency department (ED) with
a patient census of 60 000 visits per
year. To be eligible, children had to ex-
perience some dehydration second-
ary to a diagnosis of gastroenteritis
according to the treating physician, be
aged from 1 to 12 years, and present
with .5 episodes of vomiting in the
preceding 12 hours.
1
In addition, to be
included, patients had to be evaluated
by 1 of the 4 participating pediatric ED
physicians while they attended in the ED.
Exclusion criteria were as follows: (1)
preexisting chronic medical condition
such as gastrointestinal disease (mal-
absorption or inammatory bowel dis-
ease); malignancy; diabetes mellitus;
cardiac, endocrine, immunologic, or
neurologic disorder; (2) suspected
surgical abdomen or gynecologic con-
dition, urinary tract infection, migraine,
or meningitis; (3) use of medication
other than acetaminophen or ibuprofen
in the previous 48 hours; (4) history of
allergy or adverse reaction to dimen-
hydrinate; (5) severe dehydration re-
quiring immediate intravenous uid
therapy; and (6) hematemesis or
hematochezia.
Onceeligibilityandexclusioncriteriawere
conrmed and written informed consent
was obtained, a standardized question-
naire detailing demographic character-
istics, medical history, and symptoms of
present illness was completed.
The interventionof interest consistedof
the administration of oral dimenhydri-
nate or placebo at a dosage of 1 mg/kg
per dose every 6 hours for 4 doses,
with a maximumdose of 200 mg/day. The
rst dose was given in the ED by the
regular ED nurses, and the patients were
kept under observation. If the patient
vomited within 5 minutes after drug in-
gestion, a second dose was given. This
interval was based on the pharmacoki-
netics of oral dimenhydrinate, which
produces an initial response within 15
minutes.
10
Fifteen minutes after the
drug administration, oral rehydration
was offered with a standardized re-
hydration solution at a rate of 0.2 mL/kg
per minute.
1
During the ED stay, degree
of dehydration, number of emesis and
diarrheal episodes, quantity of uid
consumed, need for intravenous rehy-
dration, and length of stay were recor-
ded. Vomiting was dened as a forceful
expulsion of stomach contents or an
involuntary effort to do so. Drooling,
spitting, productive cough, and food
spilling were not considered vomiting
episodes. Nausea was dened as feeling
the need to throw up.
Complementary investigations, need for
intravenous rehydration, duration of ob-
servation, discharge, and hospitalization
decisionswereleft tothediscretionof the
attending physician.
After patient discharge from the ED,
parents were instructed to give the
medication every 6 hours for an addi-
tional 3 doses, to continue oral re-
hydration. Telephone follow-ups were
conducted by a research assistant on
days 1, 3, and 7 and, if necessary, every
second day until the patient was
symptom free, to assess patients sta-
tus via a standardized questionnaire.
A randomization table was used to
generate block randomization of vari-
able size. Randomization was stratied
according to category of age (,8 and
$8 years) to prevent uneven distribu-
tion of ages. All providers, patients,
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parents, and research assistants were
blinded to group assignment until com-
pletion of data analysis. To do so, the
pharmacy provided a bottle labeled GAG
study drug precalculated to provide
a dose of 3 mg/mL of dimenhydrinate or
a color-, taste-, and odor-matched pla-
cebo in identical packaging. Medication
kits were consecutively numbered and
assigned to the patients according to
their stratum and the order of recruit-
ment. At the pharmacy, the patients
identication was coded so that only
a user having the access code would
have been able to identify patients
allocation.
The primary outcome measure was
treatment failure as dened by the
occurrence of $2 episodes of vomiting
in the 24 hours after administration of
the rst dose of the study medication.
The secondary outcomes were as fol-
lows: (1) intravenous uid administra-
tion; (2) hospitalization; (3) the number
of episodes and duration of vomiting
and diarrhea; (4) the elapsed time be-
fore complete resolution of gastroen-
teritis symptoms; (5) reported adverse
effects; (6) ED revisits within 7 days;
and (7) parental work absenteeism.
The data were collected via the ED me-
dical records, the standardized ques-
tionnaires lled by investigators during
the ED stay, and telephone interviews.
Data were entered in an Excel data le
(Microsoft Corporation, Redmond, WA).
Based on previously reported data, we
estimated that 70% of patients would
have #1 episode of emesis in the 24
hours after the rst medication dose.
11
We prospectively dened that the min-
imal improvement which would be
clinically signicant would be to im-
prove the success rate from 70% to
90% for the participants in the inter-
vention group. We therefore calculated
that we would need 60 patients per
group to have a power of 80% with an a
error of .05. However, to compensate for
possible dropouts, we recruited at least
75 patients per group. Patients char-
acteristics and outcomes were com-
pared using the MannWhitney U test
and the x
2
test for categorical variables
and Students t test for continuous
variables. To account for the effect of
multiple comparisons, a Bonferroni
estimation was applied to consider
that a result would be statistically sig-
nicant. Accordingly, all results of the 7
secondary outcomes would be declared
signicant at a P = value of .05/7 = .007.
Analysis followed an intention-to-treat
approach with the exclusion of patients
lost to follow-up. A sensitivity analysis
evaluating worst-case and best-case
scenarios was performed to account
for patients lost to follow-up. We esti-
mated that the worst-case scenario
would imply a 25% dropout.
The study was approved by our insti-
tutional review board, and all patients/
guardians provided written informed
consent to participate in the study.
RESULTS
A total of 209 patients were eligible for
inclusionwhilethedesignatedphysicians
were attending in the ED between April
2005 and October 2010. Seven patients
were missed and of the remaining 202
patients who were approached, 50 re-
fused to participate (Fig 1). Of the 152
recruited patients, 8 patients were lost
to follow-up. A total of 144 participants
were thus included in the primary
analysis using an intention-to-treat ap-
proach. Of these, 74 were randomized to
the dimenhydrinate group and 70 to the
placebo group.
The baseline characteristics of study
participants are described in Table 1.
Participants in both groups had sim-
ilar demographic and clinical char-
acteristics.
As reported in Table 2, the proportions
of participants with $2 vomiting epi-
sodes were similar for both treatment
groups: dimenhydrinate, 31% (23 of
74); placebo, 29%(20 of 70) (difference:
0.02 [95% condence interval (CI): 0.12
to 0.17]). Data were unknown for 2 par-
ticipants in the treatment group and 6 in
the placebo group. Accordingly, the
worst-case scenario would lead to a dif-
ference of proportion of treatment fail-
ure of 0.07 (95%CI: 0.08 to 0.21) in favor
of dimenhydrinate whereas the best-
case scenario would lead to a differ-
ence of proportion of treatment failure
of 0.04 (95% CI: 0.11 to 0.18) in favor of
placebo.
There were no statistical differences be-
tweenthe2groupsforrateof intravenous
insertion, mean number of episodes of
vomiting and diarrhea, abdominal pain,
nausea, duration of symptoms, revisit
rates, and parental absenteeism.
The proportions of reported adverse
effects were high but similar in both
FIGURE 1
Patient ow.
1052 GOUIN et al
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groups (53% vs 54%) (Table 3). The
main adverse effect was drowsiness
in 42% and 37% of the participants,
respectively.
A secondary, per-protocol analysis was
performed among the 105 participants
reporting the use of all 4 doses of
medication. This analysis found no as-
sociation between treatment arms and
all outcomes of interest (Table 4).
Blinding was maintained as demon-
strated by the fact that the physicians
correctly identied the medication al-
locationin44%of theparticipantsinthe
intervention group and in 54% of the
participants in the placebo group.
DISCUSSION
This study found that oral dimenhy-
drinatedidnot signicantly decreasethe
frequency of vomiting in children with
acute gastroenteritis compared with
placebo. In addition, our study reported
similar adverse effect proportions for
dimenhydrinate and placebo, which sug-
gests that it is a safe medication.
Our results are in agreement with a
previous study conducted by Uhlig et al
9
that had evaluated the efcacy and
safety of dimenhydrinate if given rec-
tally. Their primary outcome was differ-
ent than ours. It was dened as weight
gain within 18 to 24 hours after ran-
domization. They had also included
patients with no dehydration and with
less vomiting before enrollment than in
our study. In their study, patients were
also recruited from pediatric practices
and not only ambulatory departments.
They reported that the change of
weight did not differ between chil-
dren who received dimenhydrinate or
placebo. However, the mean number
of vomiting episodes between ran-
domization and follow-up visit was
0.64 in the dimenhydrinate group and
1.36 in the placebo group. In total,
69.6% of the children in the dimen-
hydrinate group versus 47.4% in the
placebo group were free of vomiting
between randomization and the
follow-up visit. Another limitation of
their study was that dimenhydrinate
was administered rectally. It is pos-
sible that the absorption of the med-
ication was limited in patients with
diarrhea.
In the past, it was suggested that di-
menhydrinate might delay other diag-
noses such as appendicitis; however,
in our study no such instance were
encountered.
12
Furthermore, the re-
ported adverse effect proles were
similar for dimenhydrinate and pla-
cebo. The hypothesized sedative effect of
dimenhydrinate might have counter-
acted the emetic effect by reducing
overall uid intake. However, a similar
frequency of drowsiness was reported
in both study groups. The issue of the
frequency of sedation attributed to di-
menhydrinate was also negated in a pre-
vious study.
9
Overall, dimenhydrinate
seems to be safe in children.
Despite the multiple antiemetic drugs
available in pediatrics, their use in gas-
troenteritis remains controversial.
1315
Despite the limited scientic evidence,
TABLE 1 Baseline Characteristics of the Study Participants (N = 144)
Characteristics Dimenhydrinate (n = 74) Placebo (n = 70)
Age, mean 6 SD, y 4.2 6 2.9 3.6 6 2.5
Weight, mean 6 SD, kg 18.7 6 9.3 16.9 6 9.2
Male, n (%) 42 (57) 37 (52)
Fever (history or present), n (%) 20 (27) 19 (27)
Trial of rehydration at home, n (%) 56 (76) 55 (79)
Overall dehydration status, n (%)
a
Mild 38 (51) 36 (51)
Moderate 33 (45) 29 (41)
Severe 0 (0) 1 (2)
Duration of symptoms, mean 6 SD, h 20.0 6 22.0 30.1 6 50.9
No. of vomiting episodes before randomization, mean 6 SD 11.3 6 6.0 12.8 6 7.3
No. of diarrhea episodes before randomization, mean 6 SD 2.2 6 4.6 3.0 6 5.1
No. of vomiting episodes in the previous 12 h, mean 6 SD 8.6 6 3.2 8.7 6 4.4
a
Missing data for 7 patients (dimenhydrinate, n = 71; placebo, n = 66).
TABLE 2 Outcomes for the Study Participants
Outcomes Dimenhydrinate
(n = 74)
Placebo
(n = 70)
Difference
(95% CI)
P
a
More than 1 vomiting episode in the
following 24 h, n (%)
23 (31) 20 (29) 0.02 (0.12 to 0.17) .45
No. of vomiting episodes in the following
24 h, mean 6 SD
1.0 61.3 1.6 6 2.7 20.61 (1.28 to 0.08) .08
No. of diarrhea episodes in the following
24 h, mean 6 SD
1.1 61.7 1.7 6 4.8 20.59 (1.76 to 0.58) .32
Intravenous insertion, n (%) 7 (9) 9 (13) 20.03 (0.14 to 0.07) .35
Admission, n (%) 1 (1) 1 (1) 0 (0.06 to 0.06) .74
No. of doses of medication, mean 6 SD 3.6 6 0.9 3.6 6 0.8 0 .82
Nausea in the following 24 h, n (%) 21 (28) 26 (37) 20.10 (0.25 to 0.06) .16
Abdominal pain in the following 24 h,
n (%)
19 (26) 23 (33) 20.07 (0.21 to 0.08) .20
Total no. of vomiting episodes in 7 d,
mean 6 SD
1.4 6 2.2 2.7 6 5.0 21.27 (2.56 to 0.01) .05
Total no. of diarrhea episodes in 7 d,
mean 6 SD
2.6 6 4.7 4.3 6 9.3 21.66 (4.11 to 0.78) .18
Adverse effects in the following 24 h,
n (%)
36 (49) 38 (54) 20.06 (0.21 to 0.10) .24
Revisit, n (%) 11 (15) 18 (26) 20.11 (0.25 to 0.03) .08
Later hospitalization, n (%) 1 (1) 1 (1) 0 (0.06 to 0.06) .74
Duration of vomiting, mean 6 SD, d 1.0 6 1.4 1.6 6 2.4 20.52 (1.17 to 0.14) .12
Duration of diarrhea, mean 6 SD, d 1.3 6 1.8 1.2 6 1.7 0.08 (0.50 to 0.66) .78
a
P value using analysis of variance for continuous outcomes and Pearson x
2
test for categorical outcomes.
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it is known that ED clinicians do often
use antiemetic agents to treat acute
gastroenteritis in children, mainly to
prevent further dehydration.
16
There
has been no study documenting the ef-
cacy of many of these drugs in the
treatment of children with acute gas-
troenteritis. This situation underscored
the need for further research on the
subject.
Recently, randomized clinical trials and
meta-analyses have studiedthe efcacy
and safety of ondansetron, a selective
5-HT3 receptor-blocking agent, in de-
creasing emesis in the ED.
1315,17,18
This
agent had shown promising results in
alleviating the frequency of vomiting in
acute gastroenteritis.
19
Reeves et al
20
demonstrated a reduction in vomiting
in children with acute gastroenteritis
receiving one dose of 0.15 mg/kg of
intravenous ondansetron compared
with placebo. However, a reduction in
the hospitalization rate was not ob-
served. Ramsook et al
11
studied the
efcacy of oral ondansetron in acute
gastroenteritis in children. The patients
who received ondansetron required in-
travenous uid less often and had fewer
hospital admissions, but after dis-
charge, had a similar number of emesis
episodes, more diarrhea, and a higher
revisit rate compared with those re-
ceiving placebo. Cubbedu et al
21
evalu-
ated the effect on emesis of a single
dose of intravenous ondansetron ver-
sus metoclopramide versus placebo
during acute gastroenteritis. Children in
the metoclopramide group had equiv-
alent vomiting episodes and more
diarrhea compared with those re-
ceiving placebo. Patients treated with
ondansetron had fewer vomiting epi-
sodes but more diarrhea than those
receiving placebo. Finally, Al-Ansari
et al
22
failed to show a difference in the
cessation of vomiting between intrave-
nous metoclopramide versus intravenous
ondansetron for children hospitalized
for gastroenteritis.
Our study had several limitations. A
priori, we had decided to recruit a
convenient sample of patients avail-
able. The patients were considered el-
igible only when 1 of the 4 designated
recruiting physicians was working in
the ED. This decision could have led to
the possibility of unintentional enroll-
ment or ascertainment bias. No data
were collected on missed and excluded
patients during the study period. There-
fore, we cannot comment on the ex-
ternal validity of our sample for the
entire population of the children vis-
iting an ED for suspected gastroen-
teritis. The study was conducted over
a signicant length of time because of
the lack of a dedicated research as-
sistant. Possible bias might also have
been introduced because the recruiting
physician was also the main medical
caregiver deciding patient disposition.
We did not perform routine stool cul-
tures to identify infectious agents as
well as laboratory tests. No clinical de-
hydration scale was systematically ap-
plied to evaluate patients degree of
dehydration.
CONCLUSIONS
The prescription of oral dimenhy-
drinate did not signicantly reduce the
proportion of children experiencing re-
current vomiting in those experiencing
acute gastroenteritis compared with
placebo. No signicant adverse effects
were encountered with the use of di-
menhydrinate in the study population.
TABLE 3 Adverse Effects for the Study Participants
Adverse Effects Dimenhydrinate (n = 69) Placebo (n = 68)
No adverse effects 32 (46) 31 (46)
Drowsiness 29 (42) 25 (37)
Headache 3 (4) 1 (2)
Rash 4 (6) 0 (0)
Hyperactivity 3 (4) 5 (7)
Mouth dryness 3 (4) 3 (2)
Gastrointestinal discomfort 3 (4) 3 (3)
Mouth ulcers 1 (2) 1 (2)
Pruritus 0 (0) 1 (2)
Bronchospasm 0 (0) 1 (2)
Weakness 1 (2) 0 (0)
Nonspecic pain 0 (0) 1 (2)
Data are presented as number (%).
TABLE 4 Per-Protocol Analysis for the Participants Who Took 4 Doses of Medication (n = 105)
Outcome Dimenhydrinate
(n = 54)
Placebo
(n = 51)
Difference
(95%CI)
P
a
More than 1 vomiting episode in the
following 24 h, n (%)
12 (22) 16 (31) 20.09 (0.25 to 0.08) .29
Mean no. of vomiting episodes in the
following 24 h
0.87 1.49 20.61 (1.36 to 0.12) .10
Mean no. of diarrhea episodes in the
following 24 h
1.00 1.28 20.27 (1.15 to 0.60) .54
Intravenous insertion, n (%) 2 (4) 4 (8) 20.04 (0.15 to 0.06) .36
Admission, n (%) 0 (0) 1 (2) 20.02 (0.10 to 0.05) .30
Nausea in the following 24 h, n (%) 13 (25) 18 (37) 20.11 (0.28 to 0.06) .18
Abdominal pain in the following 24 h,
n (%)
12 (23) 15 (31) 20.07 (0.24 to 0.09) .36
Adverse effects in the following 24 h,
(n (%)
29 (54) 28 (56) 20.01 (0.20 to 0.17) .81
Reconsultation, n (%) 7 (13) 12 (23) 20.11 (0.25 to 0.04) .17
Mean duration of vomiting, d 0.92 1.40 20.48 (1.18 to 0.22) .18
Mean duration of diarrhea, d 1.19 1.14 0.04 (0.64 to 0.74) .89
a
P value using analysis of variance for continuous outcomes and Pearson x
2
test for categorical outcomes.
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ARTICLE
PEDIATRICS Volume 129, Number 6, June 2012 1055
at Indonesia:AAP Sponsored on August 22, 2013 pediatrics.aappublications.org Downloaded from
DOI: 10.1542/peds.2011-2945
; originally published online May 14, 2012; 2012;129;1050 Pediatrics
Serge Gouin, Thuy-Tien Vo, Michel Roy, Denis Lebel and Jocelyn Gravel
Randomized Controlled Trial
Oral Dimenhydrinate Versus Placebo in Children With Gastroenteritis: A

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