Adherence to guidelines for management of children hospitalized for acute diarrhea
Andrea Lo Vecchio1, Ilaria Liguoro, Dario Bruzzese
1From the *Section of Pediatrics, Department of Translational Medical Science; †Department of Public Health, University of Naples "Federico II", Napoli, Italy; ‡Department of Pediatrics, Hospital of Magenta, Azienda Ospedaliera "Ospedale Civile di Legnano", Magenta, Italy; and §Department of Pediatrics, Hospital of Lodi, Lodi, Italy.
Insights
Many children hospitalized for acute gastroenteritis (AGE) in Italy receive inappropriate medical care. Adherence to evidence-based guidelines is needed to improve pediatric care quality for AGE.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Acute gastroenteritis (AGE) in children leads to significant healthcare burdens, including hospitalizations and medical interventions.
- Adherence to evidence-based recommendations for managing pediatric AGE across Europe is not well-documented.
Purpose of the Study:
- To evaluate hospital medical interventions for children admitted with AGE in Italy.
- To compare these interventions against established European guidelines for pediatric gastroenterology and infectious diseases.
Main Methods:
- A multicenter prospective study involving 31 Italian hospitals.
- Data collected via an online clinical reporting form for 612 hospitalized children with AGE.
- Comparison of interventions with European guidelines to assess compliance and identify violations.
Main Results:
- Over half (57.5%) of hospital admissions for pediatric AGE were deemed inappropriate.
- Only 20.6% of children were managed in full compliance with guidelines; 44.7% had partial compliance.
- Common guideline violations included unnecessary microbiologic tests, diet changes, and non-recommended probiotics, antibiotics, or antidiarrheal drugs.
Conclusions:
- Inappropriate hospital admissions and medical interventions persist in the management of pediatric AGE in Italy.
- There is a clear need for better implementation of guideline recommendations to enhance the quality of care for children with AGE.
Background:
The major burden of acute gastroenteritis (AGE) in childhood is related to its high frequency and the large number of hospitalizations, medical consultations, tests and drug prescriptions. The adherence to evidence-based recommendations for AGE management in European countries is unknown. The purpose of the study was to compare hospital medical interventions for children admitted for AGE with recommendations reported in the European Societies of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Infectious Diseases guidelines.
Methods:
A multicenter prospective study was conducted in 31 Italian hospitals. Data on children were collected through an online clinical reporting form and compared with European Societies of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Infectious Diseases guidelines for AGE. The main outcomes were the inappropriate hospital admissions and the percentage of compliance to the guidelines (full >90%, partial >80% compliance) based on the number and type of violations to evidence-based recommendations.
Results:
Six-hundred and twelve children (53.6% male, mean age 22.8 ± 15.4 months) hospitalized for AGE were enrolled. Many hospital admissions (346/602, 57.5%) were inappropriate. Once admitted, 20.6% (126/612) of children were managed in full compliance with the guidelines and 44.7% (274/612) were managed in partial compliance. The most common violations were requests for microbiologic tests (404; 35.8%), diet changes (310; 27.6%) and the prescription of non-recommended probiotics (161; 14.2%), antibiotics (103; 9.2%) and antidiarrheal drugs (7; 0.6%).
Conclusions:
Inappropriate hospital admissions and medical interventions are still common in the management of children with AGE in Italy. Implementation of guidelines recommendations is needed to improve quality of care.
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