O1022: Impact of Hurricane Helene on pediatric intravenous fluid use in the emergency department

Background: Intravenous fluids (IVF) are an essential medical treatment for children with shock and other acute illnesses. Following Hurricane Helene, there was a shortage of IVF availability, which prompted a need for conservation efforts. We sought to compare IVF usage before and during the IVF shortage and analyze its impact on patient outcomes among children in the emergency department (ED).

Methods: We performed a cross-sectional study using data from 42 pediatric hospitals of ED encounters for children ( < 18 years) between August 1, 2024, to December 15, 2024. Our outcome of interest was IVF use. We identified key periods in IVF using breakpoint analysis. We identified associations between time period and hospitalizations, 7-day ED return visits, return visits leading to hospitalization, and blood testing in generalized linear mixed models.

Results: We identified 1,174,738 encounters for children. IVF was given in 11.5% of encounters. We identified two breakpoints on October 4, 2024, and October 24, 2024. We classified the period between October 4, 2024, and October 24, 2024, as the early IVF shortage period and the period after October 24, 2024, as late IVF shortage period (Figure 1). During the pre-IVF shortage period, 65,949/514,135 (12.8%) of encounters were given IVF. During the early shortage period, 18,038/177,215 (10.2%) were given IVF, representing a decrease of 20.3% in IVF use from the pre-IVF shortage baseline. During the late IVF shortage period, 50,658/483,388 (10.5%) were provided IVF. During the early IVF shortage, there was a decrease of IVF by 1.37% of all ED encounters (95% confidence interval [CI] -1.94, -0.78%), with a negative slope (0.09% fewer encounters given IVF per day, 95% CI -0.12, -0.06%). During the late IVF shortage, there was a positive increase in IVF use by 0.57% (95% CI 0.10, 1.06%), with a positive slope (0.03% increase in IVF use per day, 0.02, 0.04%). Evaluating the most common ED diagnoses, a breakpoint suggesting a decrease in IVF use was identified in early October 2024 for respiratory diseases, ear, nose, and throat, dental and mouth diseases, gastrointestinal diseases, and systemic states. During the early IVF shortage period, the odds of admission (adjusted odds ratio [aOR] 0.93, 95% CI 0.91-0.95) and the odds of blood testing (0.89, 95% CI 0.88-0.91) were reduced, the odds of return visit were slightly higher (aOR 1.03, 1.01-1.05). The early IVF shortage period was not associated with admission on return visit (aOR 1.02, 0.96-1.08; Table 1).

Conclusion: The IVF shortage led to measurable changes in fluid administration practices, with minor changes to hospitalizations and return visits, but with notable reductions in ancillary testing. This analysis provides a baseline for sustainable conservation efforts during future shortages.