ORIGINAL ARTICLE A prospective comparative study of children with gastroenteritis: emergency department compared with symptomatic care at home Otto G. Vanderkooi 1 & Jianling Xie 2 & Bonita E. Lee 3 & Xiao-Li Pang 4 & Linda Chui 4 & Daniel C. Payne 5 & Judy MacDonald 6 & Samina Ali 3 & Shannon MacDonald 7 & Steve Drews 8 & Lara Osterreicher 9 & Kelly Kim 10 & Stephen B. Freedman 11 & on behalf of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) and Pediatric Emergency Research Canada (PERC) Received: 28 June 2019 /Accepted: 26 August 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Little is known about the epidemiology and severity of gastroenteritis among children treated at home. We sought to compare illness severity and etiology between children brought for emergency department (ED) care to those managed at home (i.e., community). Prospective cohort study of children enrolled between December 2014 and December 2016 in two pediatric EDs in Alberta, Canada along with children treated at home after telephone triage (i.e., community). Primary outcomes were maximal frequency of vomiting and diarrhea in the 24-h pre-enrollment period; secondary outcomes included etiologic pathogens, dehydration severity, future healthcare visits, and treatments provided. A total of 1613 patients (1317 ED, 296 community) were enrolled. Median maximal frequency of vomiting was higher in the ED cohort (5 (3, 10) vs. 5 (2, 8); P < 0.001). Proportion of children with diarrhea and its 24-h median frequency were lower in the ED cohort (61.3 vs. 82.8% and 2 (0, 6) vs. 4 (1, 7); P < 0.001, respectively). In regression analysis, the ED cohort had a higher maximum number of vomiting episodes pre-enrollment (incident rate ratio (IRR) 1.25; 95% CI 1.12, 1.40) while the community cohort had higher maximal 24-h period diarrheal episodes (IRR 1.20; 95% CI 1.01, 1.43). Norovirus was identified more frequently in the community cohort (36.8% vs. 23.6%; P < 0.001). Children treated in the ED have a greater number of vomiting episodes; those treated at home have more diarrheal episodes. Norovirus is more common among children treated symptomatically at home and thus may represent a greater burden of disease than previously thought. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-019-03688-8) contains supplementary material, which is available to authorized users. * Stephen B. Freedman stephen.freedman@ahs.ca 1 Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences and the Alberta Children’ s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada 2 Section of Pediatric Emergency Medicine, Alberta Children’ s Hospital, University of Calgary, Calgary, Alberta, Canada 3 Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children’ s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada 4 Public Health Laboratory (ProvLab), Alberta Public Laboratories, Edmonton, Alberta, Canada and the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada 5 National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA 6 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 7 Faculty of Nursing, University of Alberta, School of Public Health, University of Alberta & Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 8 Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada 9 Provincial Clinical Programs, Health Link, Alberta Health Services, Edmonton, Alberta, Canada 10 Department of Pediatrics, Calgary, Alberta, Canada 11 Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children’ s Hospital, Alberta Children’ s Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta T3B 6A8, Canada https://doi.org/10.1007/s10096-019-03688-8 European Journal of Clinical Microbiology & Infectious Diseases (2019) 38:2371–2379 /Published online: 9 September 2019