Adherence to guidelines for management of children hospitalized for acute diarrhea.
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.
From 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.
Andrea
A
Lo Vecchio
Ilaria
I
Liguoro
Dario
D
Bruzzese
Riccardo
R
Scotto
Luciana
L
Parola
Gianluigi
G
Gargantini
Alfredo
A
Guarino
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000930:Antidiarrheals / Q000627:therapeutic use; D002675:Child, Preschool; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005247:Feeding Behavior; D005260:Female; D005759:Gastroenteritis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D008828:Microbiological Techniques / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D019936:Probiotics / Q000627:therapeutic use; D011446:Prospective Studies
D000900:Anti-Bacterial Agents; D000930:Antidiarrheals