Objectives: Although the passage of blood in stools in children represents a medical emergency, children seeking emergency department (ED) care remain poorly characterized. Our primary objective was to compare clinical characteristics and etiologic pathogens in children with acute diarrhea with and without caregiver-reported hematochezia. Secondary objectives were to characterize interventions and resource utilization. Methods:We conducted a secondary analysis of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) database. Children <18 years presenting to two pediatric EDs within a 24-hour period and <7 days of symptoms were consecutively recruited. Results: Of 1,061 participants, 115 (10.8%) reported hematochezia at the enrollment visit at which time those with hematochezia, compared to those without, had more HEMATOCHEZIA IN CHILDREN WITH ACUTE DIARRHEA SEEKING EMERGENCY DEPARTMENT CARE -A PROSPECTIVE COHORT STUDY INTRODUC TI ON Acute onset of blood in stools is a medical emergency 1 with etiologies varying with age. 2 Bacterial infections are a common consideration in children with hematochezia across all age groups 2 with Shigella spp., Campylobacter spp., Salmonella spp., Yersinia spp., Escherichia coli O157:H7, and other Shiga toxin-producing E. coli (STEC) being most often implicated. 1 However, viruses such as rotavirus, enteric adenovirus, and norovirus have also been detected in children in whom the diarrhea contains visible blood, but the pathogenesis remains unclear. 3,4 Furthermore, Clostridioides difficile infection must also be considered in the appropriate clinical scenario, with the most important risk factors being recent antibiotic use and hospitalization. 5,6 Pediatric bacterial enteric infections are associated with an acute onset of diarrhea, greater stool frequency in the 24 hours before emergency department (ED) presentation, abdominal tenderness, absence of vomiting, history of fever, 1,3,7-12 and spring/summer seasonality. 8,10,12-14 Although reports have described the etiologies of bloody stools associated with gastroenterology consultation and care, to the best of our knowledge, no publications have focused on the clinical features, infectious etiologies, and health care resource use of children with acute hematochezia seeking ED care. We sought to fill this knowledge gap by conducting a secondary analysis of the Alberta Provincial Pediatric EnTeric TEam (APPETITE) dataset. The latter was created through the conduct of a large, prospective cohort study of children with vomiting and diarrhea that conducted extensive stool testing using a broad, nucleic acid-based, enteropathogen detection strategy. 15-19 Our primary objective was to describe and compare the clinical characteristics and infectious etiologies of children with acute diarrhea and hematochezia presenting for ED care to those without hematochezia. Secondary objectives included a description and comparison of health care resource utilization by children with and without hematochezia. ME THODS Study design and p...

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Introduction: Acute bloody diarrhea obligates rapid and accurate diagnostic evaluation; few studies have described such cohorts of children. Methods: We conducted a planned secondary analysis employing the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) acute gastroenteritis study cohort to describe the characteristics of children with acute bloody diarrhea, compared to a cohort of children without hematochezia. Children <18 years of age presenting to 2 pediatric tertiary care emergency departments (EDs) in Alberta, with ≥3 episodes of diarrhea and/or vomiting in the preceding 24 hours and <7 days of symptoms were consecutively recruited. Stools were tested for 17 viruses, bacteria and parasites. Primary outcomes were clinical characteristics and pathogens identified. Secondary outcomes included interventions and resource utilization. Results: Of 2257 children enrolled between October 2015 and August 2018, hematochezia before or at the index ED visit was reported in 122 (5.4%). Compared to children with nonbloody diarrhea, children with hematochezia had longer illness duration [59.5 vs. 41.5 hrs, difference 10.6, 95% CI 3.5, 19.9], more diarrheal episodes in a 24-hour period [8 vs. 5, difference 3, 95% CI 2, 4], and less vomiting [55.7% vs. 91.1%; difference -35.3%; 95% CI -44.7, -26.3]. They received more intravenous fluids [32.0% vs. 18.3%; difference 13.7%, 95% CI 5.5, 23.0], underwent non-study stool testing [53.7% vs. 4.8%; difference 49.0%, 95% CI 39.6, 58.0], experienced longer ED visits [4.1 vs. 3.3 hours, difference 0.9, 95% CI 0.3, 1.0] and were more likely to have repeat healthcare visits within 14 days [54.8% vs. 34.2%; difference 20.6%, 95% CI 10.8, 30.1]. A bacterial enteric pathogen was found in 31.9% of children with hematochezia versus 6.6% without bloody diarrhea (difference 25.4%, 95% CI 17.2, 34.7). In children with hematochezia, the most commonly detected bacteria were Salmonella spp. (N = 15), Shiga toxin-producing E. coli (N = 9), Campylobacter spp. (N = 7), and Shigella spp. (N = 5). Viruses were detected in 32.8% of children with bloody diarrhea, most commonly adenovirus (N = 15), norovirus (N = 14), sapovirus (N = 8) and rotavirus (N = 7). Conclusion: Children with hematochezia differed clinically from those without hematochezia and required more healthcare resources. While bacterial etiologies are common, several viruses were also detected.