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Published on: November 7, 2018
Clinical Impact of Multiplex Molecular Diagnostic Testing in Children with Acute Gastroenteritis Presenting to An
Insights
Multiplex molecular diagnostic panels for acute gastroenteritis in children significantly increased pathogen detection and reduced healthcare return visits by 21%. Further research is needed to identify specific patient groups who benefit most from this testing.
Area of Science:
- Pediatric infectious diseases
- Molecular diagnostics
- Health services research
Background:
- Multiplex molecular diagnostic panels improve gastrointestinal pathogen detection.
- Limited data exists on the impact of these tests on clinical and patient-centered outcomes.
Approach:
- A prospective, multicenter, stepped-wedge trial was conducted in five academic children's hospitals.
- Children presenting to the emergency department (ED) with acute gastroenteritis were enrolled.
- Caregivers were interviewed to assess symptoms, risk factors, subsequent medical visits, and family impact.
Key Points:
- Multiplex molecular testing identified pathogens in 74% of cases compared to 3.3% with clinician-ordered tests.
- A 21% reduction in return visits within 10 days was observed with multiplex testing.
- Appropriate treatment prescription rates showed no significant difference between groups.
Conclusions:
- Routine multiplex molecular testing for pediatric acute gastroenteritis increases pathogen detection and decreases return healthcare visits.
- Additional research is required to pinpoint patient populations that derive the most benefit from this diagnostic approach.
Background:
Multiplex molecular diagnostic panels have greatly enhanced detection of gastrointestinal pathogens. However, data on the impact of these tests on clinical and patient-centered outcomes are limited.
Methods:
We conducted a prospective, multicenter, stepped-wedge trial to determine the impact of multiplex molecular testing at five academic children's hospitals in children presenting to the ED with acute gastroenteritis. Caregivers were interviewed on enrollment and again 7-10 days after enrollment to determine symptoms, risk factors, subsequent medical visits, and impact on family members. During the pre-intervention period, diagnostic testing was performed at the discretion of clinicians. During the intervention period, multiplex molecular testing was performed on all children with results available to clinicians. Primary outcome was return visits to a health care provider within 10 days of enrollment.
Results:
Potential pathogens were identified by clinician ordered tests in 19/571 (3.3%) in the pre-intervention period compared to 434/586 (74%) in the intervention period; clinically relevant pathogens were detected in 2.1% and 15% respectively. In the multivariate model adjusting for potential confounders, the intervention was associated with a 21% reduction in the odds of any return visit (OR 0.79; 95% CI 0.70-0.90). Appropriate treatment was prescribed in 11.3% compared to 19.6% during the intervention period(P=0.22).
Conclusions:
Routine molecular multiplex testing for all children presenting to the ED with AGE detected more clinically relevant pathogens and led to a 21% decrease in return visits. Additional research is needed to define patients most likely to benefit from testing.
