Clinical Impact of a Diagnostic Gastrointestinal Panel in Children
Jillian M Cotter1, Jacob Thomas2, Meghan Birkholz3
1Department of Pediatrics, Sections of Hospital Medicine, jillian.cotter@childrenscolorado.org.
Insights
Rapid multiplex gastrointestinal panels (GIP) increased pathogen detection and speed in children but improved outcomes for few. Unrestricted GIP use may lead to low-value care, necessitating diagnostic stewardship.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Diagnostics
- Health Services Research
Background:
- Hospitals increasingly adopt rapid multiplex polymerase chain reaction gastrointestinal panels (GIP) over conventional stool diagnostics.
- The clinical impact of GIP testing in pediatric populations remains unevaluated.
Purpose of the Study:
- To compare the utilization, results, and patient outcomes of GIP testing versus conventional stool diagnostics in children.
- To assess the impact on length of stay, ancillary testing, and hospital charges.
Main Methods:
- A multicenter, cross-sectional study comparing children undergoing stool testing between 2013-2017.
- Analysis of test use, results, length of stay, ancillary testing, and charges in the GIP era versus the conventional diagnostic era.
Main Results:
- GIP testing increased by 21% and positive results rose significantly (40% vs 11%).
- Time to result and treatment decreased substantially (4 vs 31 hours and 11 vs 35 hours, respectively).
- A 2-day decrease in length of stay was observed for a small subset (3%) treated for bacterial/parasitic pathogens; overall LOS, ancillary testing, and charges showed no significant difference.
Conclusions:
- GIP testing enhances pathogen detection and accelerates results in children.
- Improved outcomes were limited to a small patient subset, indicating potential for low-value care with unrestricted use.
- Diagnostic stewardship is crucial for optimizing GIP utilization in pediatric settings.
Objectives:
Many hospitals have transitioned from conventional stool diagnostics to rapid multiplex polymerase chain reaction gastrointestinal panels (GIP). The clinical impact of this testing has not been evaluated in children. In this study, we compare use, results, and patient outcomes between conventional diagnostics and GIP testing.
Methods:
This is a multicenter cross-sectional study of children who underwent stool testing from 2013 to 2017. We used bivariate analyses to compare test use, results, and patient outcomes, including length of stay (LOS), ancillary testing, and hospital charges, between the GIP era (24 months after GIP introduction) and conventional diagnostic era (historic control, 24 months before).
Results:
There were 12 222 tests performed in 8720 encounters. In the GIP era, there was a 21% increase in the proportion of children who underwent stool testing, with a statistically higher percentage of positive results (40% vs 11%), decreased time to result (4 vs 31 hours), and decreased time to treatment (11 vs 35 hours). Although there was a decrease in LOS by 2 days among those who received treatment of a bacterial and/or parasitic pathogen (5.1 vs 3.1; P < .001), this represented only 3% of tested children. In the overall population, there was no statistical difference in LOS, ancillary testing, or charges.
Conclusions:
The GIP led to increased pathogen detection and faster results. This translated into improved outcomes for only a small subset of patients, suggesting that unrestricted GIP use leads to low-value care. Similar to other novel rapid diagnostic panels, there is a critical need for diagnostic stewardship to optimize GIP testing.
Related Concept Videos
01:30Serum Laboratory Studies, Stool Test, Breath Test
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:17Assessment of the Gastrointestinal System I: Subjective Data
Health History
The initial step in assessing the GI system is obtaining a comprehensive health history. This includes inquiring about the patient's history or presence of problems...
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:29Assessment of the Gastrointestinal System II: Health Perception Pattern
Health Perception Patterns
Health perception patterns offer valuable insights into a patient's lifestyle habits and how they may impact their GI health. These patterns include: