Practice guidelines for ordering stool ova and parasite testing in a pediatric population. The Alberta Children's Hospital

Abstract

A comprehensive utilization review was done of all stool ova parasite examinations performed at a pediatric hospital during a 3-year period from June 1, 1989 to July 1, 1992. A total of 2,652 stool specimens were surveyed from 1,532 children. Forty-one percent (1,081) of the workload was from inpatients, 37% (976) was from emergency room (ER) visits/other outpatients, and 22% (233) was from patients attending the gastroenterology (GI) clinic. The prevalence of enteric parasites in hospitalized children was 4% (35 of 829) compared to rates of 10% (47 of 470) and 13% (30 of 233) for children attending the ER/other outpatient clinics and GI clinic, respectively. Giardia lamblia was found most often (31%[45 of 146]), followed by Dientamoeba fragilis (23%[33 of 146]), Entamoeba coli (16%[24 of 146]), Blastocystis hominis (13% [19 of 146]), Cryptosporidium (8% [12 of 146]), Endolimax nana (4% [6 of 146]), Enterobius vermicularis (2% [3 of 146]), Hymenolepis nana (2% [3 of 146]), and Iodamoeba buetschlii (1% [1 of 146]). Most children were colonized/infected with a single parasite (85%) with a much smaller number having two or more parasites. Only nine children (6%) who were immunocompetent and hospitalized for more than 4 days were found to have enteric parasites. Over the past 18 months, significant sustainable cost savings have resulted from the implementation of practice guidelines for ordering pediatric stool ova and parasite examinations.