Variation in stool testing for children with acute gastrointestinal infections

Area of Science:

• Pediatric Gastroenterology
• Clinical Diagnostics
• Healthcare Quality Improvement

Background:

• Acute gastrointestinal infections are common in children, necessitating acute care.
• Variations in diagnostic testing practices can impact healthcare resource utilization and patient outcomes.

Purpose of the Study:

• To describe variations in stool testing patterns among children's hospitals.
• To determine if stool testing variations are associated with utilization outcomes such as length of stay, costs, and revisit rates.

Main Methods:

• Multicenter, cross-sectional study using the Pediatric Health Information System (PHIS) database.
• Analysis of stool testing (multiplex PCR, stool culture, ova and parasite, C. difficile) in children with acute gastrointestinal infections.
• Stratification of hospitals into low, moderate, and high testing groups; generalized estimating equations used to assess outcome associations.

Main Results:

• Over 498,000 ED-only and 40,000 hospitalized encounters analyzed from 2016-2020.
• Stool testing was more frequent in hospitalized children (1.5%-13.8%) compared to ED-only encounters (0.1%-2.3%).
• Significant variation in testing rates observed across hospitals, with no statistically significant differences in length of stay, costs, or revisit rates among testing groups.

Conclusions:

• Substantial variation exists in stool testing for pediatric gastrointestinal infections within and across hospitals.
• Current variations in stool testing did not correlate with significant differences in key utilization outcomes.
• Findings emphasize the need for standardized guidelines to improve diagnostic stewardship in pediatric care.