The role of rapid syndromic diagnostic testing of gastrointestinal pathogens as a clinical decision support tool in a pediatric emergency department

Abstract

Purpose: This study aimed to investigate the role of rapid syndromic diagnostic testing of gastrointestinal pathogens as a clinical decision support tool in a pediatric emergency department (ED) by comparing clinical decision and patient outcome parameters pre- and post-implementation.

Methods: This was a big data analytical study of children < 18 years old without any underlying diseases, that visited the ED with acute moderate to severe diarrhea during a 34-month period from 2018 to 2022 using Seoul St. Mary's hospital's healthcare corporate data warehouse to retrieve demographic, clinical, and laboratory parameters. Outcome measures pre- and post-implementation of a rapid syndromic multiplex gastrointestinal panel (GI panel) were compared.

Results: A total of 4,184 patients' data were included in the analyses. Broad spectrum antibiotics were prescribed at a significantly lower rate to patients presenting with acute infectious diarrhea at discharge from the ED (9.9% vs 15.8%, P < 0.001) as well as upon admission (52.2% vs 66.0%, P < 0.001) during the post-implementation period compared to the pre-implementation period. Although the duration of ED stay was found to be significantly longer (6.5 vs 5.5 h, P < 0.0001), the rate of ED revisit due to persistent or aggravated symptoms was significantly lower (Δ in intercept, β = -0.027; SE = 0.013; P = 0.041), and the admission rate at follow up after being discharged from the ED shown to be significantly lower during the post-implementation period compared to the pre-implementation period (0.8% vs. 2.1%, P = 0.001, respectively). No significant difference in disease progression was observed (P = 1.000).

Conclusion: Using the GI panel in the ED was shown to decrease broad spectrum antibiotic prescribing practices and reduce revisits or admission at follow up by aiding clinical decisions and improving patient outcome.

Keywords: Children; Diarrhea; Emergency department; Stool; Syndromic multiplex diagnostic testing.

Fig. 1

Flow chart of the patients included in this study. ED emergency department

Fig. 2

Monthly distribution of cases that visited the ED for symptoms of acute infectious diarrhea. Prior to the incorporation of the syndromic gastrointestinal panel test in the ED, an average 153.6 (standard deviation [SD] ± 28.2) patients visited the ED for acute infectious diarrhea, whereas after the incorporation, which was during the early COVID-19 period, an average 92.6 (SD ± 28.4) patients visited the ED. COVID-19 coronavirus disease 2019, ED emergency department

Fig. 3

a Syndromic GI pathogen panel test positivity. An significant increase in test positivity rate was observed (β 2.5; 95% CI, 1.6–3.4; P < 0.001) as time passed after implementation, and b Subgroup analyses of outcome parameters in test-negative and test-positive patients. CI Confidence interval, GI Gastrointestinal

Fig. 4

Primary outcome parameters. During the post-implementation period, a trend in decrease in no. of patients prescribed antibiotics a at ED discharge (ꞵ, − 0.745; 95% CI, -1.6–0.1; P = 0.093), and b a significant decrease at admission (ꞵ,− 1.2; 95% CI, − 2.0–− 0.4; P = 0.003). Furthermore, c) a significant immediate increase in the number of consults made to infectious disease specialists regarding isolation precautions (Δ in intercept, 0.031, SE, 0.010, P = 0.002) after the incorporation of syndromic gastrointestinal panel testing in the pediatric emergency department, as well as d) a significant immediate decrease in the time taken to exercise appropriate isolation precaution measures to patients at wards (Δ in intercept, -1.397, SE, 0.455, P = 0.003)