Background Infections by previously under-diagnosed viruses astrovirus and sapovirus are poorly characterized compared to norovirus, the most common cause of acute gastroenteritis. Methods Children <18-years-old with acute gastroenteritis were recruited from pediatric emergency departments in Alberta, Canada, 2014-2018. We described and compared the clinical course of acute gastroenteritis in children with astrovirus, sapovirus, and norovirus. Results Astrovirus was detected in 56/2,688 children (2.1%), sapovirus in 146/2,688 (5.4%), and norovirus in 486/2,688 (18.1%). At illness onset, ~60% of astrovirus cases experienced each of diarrhea and vomiting. Among sapovirus and norovirus cases, 35% experienced diarrhea at onset and 80%/91% (sapovirus/norovirus) vomited; however, diarrhea became more prevalent than vomiting around day 4 of illness. Over the full course of illness, diarrhea was 18% (95% CI 8%, 29%) more prevalent among children with astrovirus than norovirus infections, as well as longer with greater maximal events; there were median 4.0 fewer maximal vomiting events (95% CI 2.0, 5.0). Vomiting continued median 24.8 hours longer (95% CI 9.6, 31.7) among children with sapovirus vs. norovirus. Differences between these viruses were otherwise minimal. Conclusion Sapovirus infections attended in the emergency department are more similar to norovirus than previously reported, while astrovirus infections have several distinguishable characteristics.

Introduction: Providing complete pending diagnostic test information and medication lists on inpatient discharge and ambulatory end-of-visit summaries decreases adverse events, reduces medical errors, and improves patient satisfaction. The purpose was to compare inpatient and ambulatory settings regarding percentages of records with documentation of pending diagnostic test result information and medication lists given at discharge/end of visit. Methods: Using a cross-sectional, observational design, 2018 NDNQI discharge/end-of-visit data from 133 inpatient and 90 ambulatory units in 20 hospitals were examined. Trained site coordinators reviewed records for documentation of discharge/end-of-visit elements. Mann–Whitney U tests were used to compare inpatient and ambulatory percent of elements completed. Results: Across all discharge/end-of-visit elements, there were differences (all p < .001) between inpatient and ambulatory settings. Ambulatory units had a lower percent completion for all medication list and pending diagnostic result elements. Depending on the element, the sample means for documentation in discharge/end-of-visit summaries were 18.6–98.8% for inpatient and 4.5–61.8% for ambulatory settings. Conclusions: Discharge instructions and end-of-visit summaries are crucial forms of communication between clinicians and patients. However, many patients are not receiving complete information. Implications: In a large nationwide sample, we found substantial opportunities to improve completeness of summaries, particularly in ambulatory settings.

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