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Yield From Stool Testing of Pediatric Inpatients

Yield From Stool Testing of Pediatric Inpatients Abstract Objectives: To quantify the yield from stool testing in pediatric inpatients and to identify criteria to test stool more deliberately without sacrificing diagnostic sensitivity. Design: A retrospective review was performed of all stool cultures, ova and parasite examinations, and Clostridia difficile toxin assays performed on pediatric inpatients, aged 3 days to 18 years, at Thomas Jefferson University Hospital, Philadelphia, Pa, for 1 year. Medical records were reviewed for positive cases, each with 2 controls matched for age and test type. For this study, the term admission refers to the interval between the times each patient was admitted to and discharged from the hospital. Some patients had multiple stool tests sent to the laboratory during a single admission; some patients had more than 1 admission during the study period. Statistical analysis was performed using χ2 analysis and the Student 2-tailed t test with a commercially available statistical software package (Statworks, Cricket Software, Philadelphia). Results: Of 250 patient admissions to the hospital for which stool was cultured, 7 cultures (2.8%) were positive. Of 63 patient admissions having ova and parasite testing, 1 (2%) had a positive result. Clostridia difficile toxin assays were performed on 40 patient admissions to the hospital, and 7 (18%) had a positive result. Only 18 (3.0%) of 598 of all test results reviewed were positive. Costs of negative test results totaled $26 084. More patients (71%) with positive stool cultures than control patients (21%) had a temperature higher than or equal to 38°C (χ2, P<.05); however, relying on this sign missed 29% of the children with bacterial infection. A white blood cell band count of at least 0.10 was 100% sensitive and 79% specific in identifying patients with positive stool culture. There was no statistically significant relationship between stool culture results and age, total white blood cell count or white blood cell segmented neutrophil count, and no relationship between C difficile toxin assay results and any of the above characteristics. Clostrida difficile was the most common pathogen identified (6 of 9) in patients developing gastrointestinal symptoms after admission; however, Salmonella enteritidis and Shigella sonnei were also significant causes (3 of 9). Conclusions: There is low yield from stool testing of pediatric inpatients; C difficile toxin assay has the highest yield. Clostridia difficile testing is most valuable for children with nosocomial gastrointestinal symptoms, although other bacterial pathogens do cause nosocomial symptoms in children. More selective stool testing could help us be more efficient with our patient care resources.Arch Pediatr Adolesc Med. 1997;151:142-145 References 1. WHO reports decry neglect of world health problems . Am Soc Microbiol News . 1990;56:358-359. 2. Ho M-S, Glass RI, Pinsky PF, et al. Diarrheal deaths in American children: are they preventable? JAMA . 1988;260:3281-3285.Crossref 3. National Hospital Discharge Survey, 1994. In: Vital and Health Statistics and Advance Data From Vital and Health Statistics. Hyattsville, Md: National Center for Health Statistics. In press. 4. Guerrant RL, Bobak DA. Bacterial and protozoal gastroenteritis . N Engl J Med . 1991;325:327-340.Crossref 5. Welliver RC, McLaughlin S. Unique epidemiology of nosocomial infection in a children's hospital . AJDC . 1984;138:131-135. 6. Koplan JP, Fineberg HV, Ferraro MJB, Rosenberg ML. Value of stool cultures . Lancet . 1980;2:413-416.Crossref 7. Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DHM. Evaluation and diagnosis of acute infectious diarrhea . Am J Med . 1985;78( (suppl 6B) ): 91-98.Crossref 8. Tarr PI, Clausen CR, Christie DL. Bacterial and protozoal gastroenteritis . N Engl J Med . 1992;326:489.Crossref 9. Siegel DL, Edelstein PH, Nachamkin I. Inappropriate testing for diarrheal diseases in the hospital . JAMA . 1990;263:979-982.Crossref 10. DeWitt TG, Humphrey KF, McCarthy P. Clinical predictors of acute bacterial diarrhea in young children . Pediatrics . 1985;76:551-556. 11. Committee on Infectious Diseases. Blastocystis hominis infections . In: Peter G, ed, 1994 Red Book: Report of the Committee on Infectious Diseases. 23rd ed. Elk Grove Village, Ill: American Academy of Pediatarics; 1994:139-140. 12. Kabani A, Cadrain G, Trevenen C, Jadavji T, Church DL. Practice guidelines for ordering stool ova and parasite testing in a pediatric population: the Alberta Children's Hospital . Am J Clin Pathol . 1995;104:272-278. 13. Arnon SS. Anaerobic infections . In: Behrman RL, Kliegman RM, Arvin AM, eds. Nelson Textbook of Pediatrics . 15th ed. Philadelphia, Pa: WB Saunders Co; 1996:819. 14. Ford-Jones EL, Mindorff CM, Gold R, Petric M. The incidence of viral-associated diarrhea after admission to a pediatric hospital . Am J Epidemiol . 1990;131:711-718. 15. Cody MM, Sottnek HM, O'Leary VS. Recovery of Giardia lamblia cysts from chairs and tables in child day-care centers . Pediatrics . 1994;94( (suppl) ):1006-1008. 16. Manwhorter SD. Eosinophilia caused by parasites . Pediatr Ann . 1994;23:405-413.Crossref 17. Meropol SB. Health status of pediatric refugees in Buffalo, NY . Arch Pediatr Adolesc Med . 1995;149:887-892.Crossref 18. Statistical Abstract of the United States . 114th ed. Washington, DC: US Bureau of the Census; 1994;14. 19. Graves, EJ, Kozak LJ. National Hospital Discharge Survey: Annal Summary 1989 . Washington, DC: National Center for Health Statistics, US Dept of Health and Human Services; 1992; 1-51. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Yield From Stool Testing of Pediatric Inpatients

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References (18)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1997.02170390032006
Publisher site
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Abstract

Abstract Objectives: To quantify the yield from stool testing in pediatric inpatients and to identify criteria to test stool more deliberately without sacrificing diagnostic sensitivity. Design: A retrospective review was performed of all stool cultures, ova and parasite examinations, and Clostridia difficile toxin assays performed on pediatric inpatients, aged 3 days to 18 years, at Thomas Jefferson University Hospital, Philadelphia, Pa, for 1 year. Medical records were reviewed for positive cases, each with 2 controls matched for age and test type. For this study, the term admission refers to the interval between the times each patient was admitted to and discharged from the hospital. Some patients had multiple stool tests sent to the laboratory during a single admission; some patients had more than 1 admission during the study period. Statistical analysis was performed using χ2 analysis and the Student 2-tailed t test with a commercially available statistical software package (Statworks, Cricket Software, Philadelphia). Results: Of 250 patient admissions to the hospital for which stool was cultured, 7 cultures (2.8%) were positive. Of 63 patient admissions having ova and parasite testing, 1 (2%) had a positive result. Clostridia difficile toxin assays were performed on 40 patient admissions to the hospital, and 7 (18%) had a positive result. Only 18 (3.0%) of 598 of all test results reviewed were positive. Costs of negative test results totaled $26 084. More patients (71%) with positive stool cultures than control patients (21%) had a temperature higher than or equal to 38°C (χ2, P<.05); however, relying on this sign missed 29% of the children with bacterial infection. A white blood cell band count of at least 0.10 was 100% sensitive and 79% specific in identifying patients with positive stool culture. There was no statistically significant relationship between stool culture results and age, total white blood cell count or white blood cell segmented neutrophil count, and no relationship between C difficile toxin assay results and any of the above characteristics. Clostrida difficile was the most common pathogen identified (6 of 9) in patients developing gastrointestinal symptoms after admission; however, Salmonella enteritidis and Shigella sonnei were also significant causes (3 of 9). Conclusions: There is low yield from stool testing of pediatric inpatients; C difficile toxin assay has the highest yield. Clostridia difficile testing is most valuable for children with nosocomial gastrointestinal symptoms, although other bacterial pathogens do cause nosocomial symptoms in children. More selective stool testing could help us be more efficient with our patient care resources.Arch Pediatr Adolesc Med. 1997;151:142-145 References 1. WHO reports decry neglect of world health problems . Am Soc Microbiol News . 1990;56:358-359. 2. Ho M-S, Glass RI, Pinsky PF, et al. Diarrheal deaths in American children: are they preventable? JAMA . 1988;260:3281-3285.Crossref 3. National Hospital Discharge Survey, 1994. In: Vital and Health Statistics and Advance Data From Vital and Health Statistics. Hyattsville, Md: National Center for Health Statistics. In press. 4. Guerrant RL, Bobak DA. Bacterial and protozoal gastroenteritis . N Engl J Med . 1991;325:327-340.Crossref 5. Welliver RC, McLaughlin S. Unique epidemiology of nosocomial infection in a children's hospital . AJDC . 1984;138:131-135. 6. Koplan JP, Fineberg HV, Ferraro MJB, Rosenberg ML. Value of stool cultures . Lancet . 1980;2:413-416.Crossref 7. Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DHM. Evaluation and diagnosis of acute infectious diarrhea . Am J Med . 1985;78( (suppl 6B) ): 91-98.Crossref 8. Tarr PI, Clausen CR, Christie DL. Bacterial and protozoal gastroenteritis . N Engl J Med . 1992;326:489.Crossref 9. Siegel DL, Edelstein PH, Nachamkin I. Inappropriate testing for diarrheal diseases in the hospital . JAMA . 1990;263:979-982.Crossref 10. DeWitt TG, Humphrey KF, McCarthy P. Clinical predictors of acute bacterial diarrhea in young children . Pediatrics . 1985;76:551-556. 11. Committee on Infectious Diseases. Blastocystis hominis infections . In: Peter G, ed, 1994 Red Book: Report of the Committee on Infectious Diseases. 23rd ed. Elk Grove Village, Ill: American Academy of Pediatarics; 1994:139-140. 12. Kabani A, Cadrain G, Trevenen C, Jadavji T, Church DL. Practice guidelines for ordering stool ova and parasite testing in a pediatric population: the Alberta Children's Hospital . Am J Clin Pathol . 1995;104:272-278. 13. Arnon SS. Anaerobic infections . In: Behrman RL, Kliegman RM, Arvin AM, eds. Nelson Textbook of Pediatrics . 15th ed. Philadelphia, Pa: WB Saunders Co; 1996:819. 14. Ford-Jones EL, Mindorff CM, Gold R, Petric M. The incidence of viral-associated diarrhea after admission to a pediatric hospital . Am J Epidemiol . 1990;131:711-718. 15. Cody MM, Sottnek HM, O'Leary VS. Recovery of Giardia lamblia cysts from chairs and tables in child day-care centers . Pediatrics . 1994;94( (suppl) ):1006-1008. 16. Manwhorter SD. Eosinophilia caused by parasites . Pediatr Ann . 1994;23:405-413.Crossref 17. Meropol SB. Health status of pediatric refugees in Buffalo, NY . Arch Pediatr Adolesc Med . 1995;149:887-892.Crossref 18. Statistical Abstract of the United States . 114th ed. Washington, DC: US Bureau of the Census; 1994;14. 19. Graves, EJ, Kozak LJ. National Hospital Discharge Survey: Annal Summary 1989 . Washington, DC: National Center for Health Statistics, US Dept of Health and Human Services; 1992; 1-51.

Journal

Archives of Pediatrics & Adolescent Medicine – American Medical Association

Published: Feb 1, 1997

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