Trends in Management of Children With Acute Gastroenteritis in US Emergency Departments

Burstein, Brett; Rogers, Sarah; Klassen, Terry P.; Freedman, Stephen B.

doi:10.1001/jamanetworkopen.2022.11201

Cited by 1 publication

(2 citation statements)

References 7 publications

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“…Children with gastrointestinal infections often require an emergency department (ED) evaluation or hospitalization. [1][2][3][4] While viruses are the most frequent cause in the United States, bacteria and parasites are important to identify as they may warrant different management, including infection prevention interventions for school or childcare. [5][6][7][8][9][10][11] The Centers for Disease Control and Prevention guidelines for the management of acute gastrointestinal infections advocate for limited use of diagnostic tests such as stool cultures.…”

Section: Introductionmentioning

confidence: 99%

“…Children with gastrointestinal infections often require an emergency department (ED) evaluation or hospitalization 1–4 . While viruses are the most frequent cause in the United States, bacteria and parasites are important to identify as they may warrant different management, including infection prevention interventions for school or childcare 5–11 .…”

Section: Introductionmentioning

confidence: 99%

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Variation in stool testing for children with acute gastrointestinal infections

Markham

Hall

Collins

et al. 2023

Journal of Hospital Medicine

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Background and Objective Children with gastrointestinal infections often require acute care.The objectives of this study were to describe variations in patterns of stool testing across children's hospitals and determine whether such variation was associated with utilization outcomes. Design, Settings and Participants We performed a multicenter, cross‐sectional study using the Pediatric Health Information System (PHIS) database. We identified stool testing (multiplex polymerase chain reaction [PCR], stool culture, ova and parasite, Clostridioides difficile, and other individual stool bacterial or viral tests) in children diagnosed with acute gastrointestinal infections. Main Outcome and Measures We calculated the overall testing rates and hospital‐level stool testing rates, stratified by setting (emergency department [ED]‐only vs. hospitalized). We stratified individual hospitals into low, moderate, or high testing institutions. Generalized estimating equations were then used to examine the association of hospital testing groups and outcomes, specifically, length of stay (LOS), costs, and revisit rates. Results We identified 498,751 ED‐only and 40,003 encounters for hospitalized children from 2016 to 2020. Compared to ED‐only encounters, stool studies were obtained with increased frequency among encounters for hospitalized children (ED‐only: 0.1%–2.3%; Hospitalized: 1.5%–13.8%, all p < 0.001). We observed substantial variation in stool testing rates across hospitals, particularly during encounters for hospitalized children (e.g., rates of multiplex PCRs ranged from 0% to 16.8% for ED‐only and 0% to 65.0% for hospitalized). There were no statistically significant differences in outcomes among low, moderate, or high testing institutions in adjusted models. Conclusions Children with acute gastrointestinal infections experience substantial variation in stool testing within and across hospitals, with no difference in utilization outcomes. These findings highlight the need for guidelines to address diagnostic stewardship.

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