title: Province-Wide Review of Pediatric Shiga Toxin-Producing Escherichia coli Case Management.
abstract: To identify the gaps in the care of children infected with Shiga toxin-producing Escherichia coli (STEC), we sought to quantitate care received and management timelines. Such knowledge is crucial to the design of interventions to prevent the development of hemolytic uremic syndrome (HUS).
  
  
  
  We conducted a retrospective case-series study of 78 children infected with STEC in Alberta, Canada, through the linkage of microbiology and laboratory results, telephone health advice records, hospital charts, physician billing submissions, and outpatient antimicrobial dispensing databases. Outcomes were the time intervals between initial presentation and reporting of positive culture result and symptom onset to HUS and to describe the proportions that had baseline blood work performed and received antibiotics.
  
  
  
  Seventy-eight children infected with STEC were identified; 13% (10/78) developed HUS. Median time from initial presentation to laboratory stool sample receipt was 33 hours (IQR 18, 42); time to positive culture was 120 hours (IQR 86, 205). Time from symptom onset to HUS diagnosis was 188 ± 37 hours. Baseline blood tests were obtained in 74% (58/78) of infected children. Antibiotics were administered to 50% (5/10) of those who developed HUS and 22% (15/78) of those who did not; P = .11. The provincial telephone advice system received 31 calls regarding 24 children infected with STEC; 23% (7/31) of callers were recommended to seek emergency department care.
  
  
  
  A significant proportion of children developed HUS following multiple interactions with the health care system. Delays in the confirmation of STEC infection occurred. There are numerous opportunities to improve the timing, monitoring, and interventions in children infected with STEC.
authors.affiliation: Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada. Electronic address: stephen.freedman@albertahealthservices.ca.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
authors.affiliation: Division of Pediatric Emergency Medicine, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Eltorki
authors.affiliation: Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Chui
authors.affiliation: Section of Pediatric Emergency Medicine, Alberta Children's Hospital, Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jianling
authors.initials: J
authors.lastname: Xie
authors.affiliation: Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Feng
authors.affiliation: Population, Public and Indigenous Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Judy
authors.initials: J
authors.lastname: MacDonald
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta.
authors.forename: Andrew
authors.initials: A
authors.lastname: Dixon
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta.
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.affiliation: Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; Department of Microbiology Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Marie
authors.initials: M
authors.lastname: Louie
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta.
authors.forename: Bonita E
authors.initials: BE
authors.lastname: Lee
authors.affiliation: Provincial Clinical Programs, Health Link, Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Lara
authors.initials: L
authors.lastname: Osterreicher
authors.affiliation: Section of Pediatric Emergency Medicine, Alberta Children's Hospital, Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Thull-Freedman
mesh_terms: D000293:Adolescent; D000416:Alberta; D000900:Anti-Bacterial Agents; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D004927:Escherichia coli Infections / Q000150:complications / Q000628:therapy*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000382:microbiology* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D054323:Shiga-Toxigenic Escherichia coli
chemical_list: D000900:Anti-Bacterial Agents
keywords: Escherichia coli; Shiga toxin; case management; hemolytic-uremic syndrome; pediatrics