Evaluation of anamnestic criteria for the identification of patients with acute community onset viral gastroenteritis in the emergency department--A prospective observational study.
BACKGROUND
To our knowledge no clinical criteria for the identification of community onset viral gastroenteritis in individual patients have been evaluated systematically with modern PCR-based diagnostic assays as gold standard.


OBJECTIVE
The aim of this study was to identify factors independently associated with the detection of virus by PCR in rectal swab samples from patients with acute community onset gastroenteritis.


METHODS
A prospective observational study was conducted from December 2010 through March 2011 at the emergency department (ED) of a large teaching hospital. All patients who reported vomiting and/or diarrhoea up to 48 h prior to their visit to the ED were asked to participate. A rectal swab sample was obtained from each patient. Symptoms, date of onset, and epidemiological data were recorded. Samples were analysed with a multiple real-time PCR targeting 6 viral agents (astrovirus, adenovirus, rotavirus, sapovirus, and norovirus GI and GII).


RESULTS
Two hundred and five patients fulfilled the inclusion criteria, of whom 66 agreed to participate; their median (IQR) age was 65 (38-84) y and 43 (65%) were females. Thirty-one (47%) were positive by PCR for at least 1 of the agents examined (26 norovirus, 2 sapovirus, 2 rotavirus, and 1 adenovirus). Diarrhoea and a short duration of symptoms (≤ 2 days) were independently associated with a positive rectal swab sample, with odds ratios of 7.5 (95% confidence interval (CI) 2.0-28) and 10.4 (95% CI 1.9-56), respectively (p < 0.01 for both). A multivariate model including these 2 variables had a sensitivity of 81% (25/31) and a specificity of 69% (24/35).


CONCLUSIONS
Diarrhoea and a short duration of symptoms were the only anamnestic criteria independently associated with acute community onset viral gastroenteritis confirmed by PCR.
From the Department of Infectious Diseases, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden.
Thomas
T
Andreasson
Lars
L
Gustavsson
Magnus
M
Lindh
Ing-Marie
IM
Bergbrant
Christina
C
Raner
Christina
C
Ahrén
Johan
J
Westin
Lars-Magnus
LM
Andersson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000473:pathology; D003967:Diarrhea / Q000209:etiology* / Q000473:pathology; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D013997:Time Factors; D014777:Virus Diseases / Q000175:diagnosis* / Q000473:pathology
Norovirus; PCR; criteria; diagnosis