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Variation in stool testing for children with acute gastrointestinal infections
Jessica L Markham1,2, Matt Hall1,3, Megan E Collins1
1Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
Insights
Pediatric gastrointestinal infection care shows wide variation in stool testing practices. Despite differences in testing, outcomes like length of stay and costs remained similar across hospitals.
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.
Background And Objective:
Children with gastrointestinal infections often require acute care.The objectives of this study were to describe variations in patterns of stool testing across children's hospitals and determine whether such variation was associated with utilization outcomes.
Design, Settings And Participants:
We performed a multicenter, cross-sectional study using the Pediatric Health Information System (PHIS) database. We identified stool testing (multiplex polymerase chain reaction [PCR], stool culture, ova and parasite, Clostridioides difficile, and other individual stool bacterial or viral tests) in children diagnosed with acute gastrointestinal infections.
Main Outcome And Measures:
We calculated the overall testing rates and hospital-level stool testing rates, stratified by setting (emergency department [ED]-only vs. hospitalized). We stratified individual hospitals into low, moderate, or high testing institutions. Generalized estimating equations were then used to examine the association of hospital testing groups and outcomes, specifically, length of stay (LOS), costs, and revisit rates.
Results:
We identified 498,751 ED-only and 40,003 encounters for hospitalized children from 2016 to 2020. Compared to ED-only encounters, stool studies were obtained with increased frequency among encounters for hospitalized children (ED-only: 0.1%-2.3%; Hospitalized: 1.5%-13.8%, all p < 0.001). We observed substantial variation in stool testing rates across hospitals, particularly during encounters for hospitalized children (e.g., rates of multiplex PCRs ranged from 0% to 16.8% for ED-only and 0% to 65.0% for hospitalized). There were no statistically significant differences in outcomes among low, moderate, or high testing institutions in adjusted models.
Conclusions:
Children with acute gastrointestinal infections experience substantial variation in stool testing within and across hospitals, with no difference in utilization outcomes. These findings highlight the need for guidelines to address diagnostic stewardship.
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