Comparison of a Rapid Multiplex Gastrointestinal Panel with Standard Laboratory Testing in the Management of Children with Hematochezia in a Pediatric Emergency Department: Randomized Controlled Trial

Abstract

Advances in diagnostic microbiology now allow for the faster and more accurate detection of an increasing number of pathogens. We determined, however, that in children with acute bloody diarrhea, these advances did not necessarily translate into improved clinical outcomes.

Etiologies of bloody diarrhea in children presenting with acute gastroenteritis to US emergency departments

“…Prior studies of bloody diarrhea in children, before the widespread availability of multiplex PCR, had been limited to conventional stool culture, immunoassays, and a limited array of PCR detection methods [5,7,8]. Our findings align with more contemporary multiplex PCR-based studies of either bloody diarrhea, or more generally hematochezia, emphasizing the complexity of attributing bloody diarrhea symptoms to specific pathogens [4].…”

“…Our analysis of data from a multi-site study revealed that in less than half of the cases with bloody diarrhea was a bacterial pathogen typically associated with this condition detected, and that in a substantial proportion (over a third) of bloody diarrhea cases, a pathogen was detected for which antibiotics was not indicated. Prior studies of bloody diarrhea in children, before the widespread availability of multiplex PCR, had been limited to conventional stool culture, immunoassays, and a limited array of PCR detection methods[5,7,8]. Our findings align with more contemporary multiplex PCR-based studies of either bloody diarrhea, or more generally hematochezia, emphasizing the complexity of attributing bloody diarrhea symptoms to specific pathogens[4].…”

“…Bloody diarrhea, or hematochezia associated with a diarrheal illness, arises from intestinal inflammation [4] and may be accompanied by dehydration, fever, and abdominal pain. Bloody diarrhea can lead to substantial healthcare utilization and medical costs [5,6]. Despite this, our knowledge of the causes of bloody diarrhea is limited mainly to single-center studies, many of which were from the pre-molecular era.…”

“…Bloody diarrhea is often associated with Shigella spp and other invasive enteropathogens such as Shiga-toxin producing E. coli (STEC), Salmonella spp, Campylobacter spp, and Yersinia spp [5,[7][8][9][10]. However, recent studies have shown that many cases of bloody diarrhea cannot be attributed to only bacteria, that STEC only accounts for a minority of cases, and in many cases, infectious etiology cannot be determined [4,11].…”