Adherence to recommended treatment guidelines for acute gastroenteritis appears to differ based on patient volume

Acute gastroenteritis (inflammation of the gastrointestinal tract, often caused by an infection) is a common condition in children for which established treatment guidelines are shown to reduce costs, length of hospital stay and duration of illness, according to background information in the article. However, "more than 30 percent of children at a sample of U.S. major children's hospitals received care inconsistent with current guidelines," write the authors.

Lisa McLeod, M.D., of the Children's Hospital of Philadelphia, and colleagues evaluated data gathered from the Premier Perspective clinical and financial information systems database to examine the relationship between the volume of children admitted to the hospital with acute gastroenteritis and hospital adherence to recommended guidelines. Adherence to guidelines was evaluated using quality indicators for overuse and misuse of care including blood testing, stool studies, use of antibiotics and use of nonrecommended antiemetic (used to treat vomiting and nausea) or antidiarrheal medications.

Included in the study were 12,604 children between 3 months and 10 years of age who were hospitalized between January 2007 and December 2009 at 280 U.S. hospitals with a diagnosis of acute gastroenteritis. The overall number of children admitted to the hospital with acute gastroenteritis ranged from one to 174 per year, with median (midpoint) patient volumes within small, medium and large categories of hospitals defined as seven, 13 and 30 children admitted per year, respectively. Almost half (46 percent) of hospitals were in Southern urban locations.

The authors found that higher volumes of hospital admissions for gastroenteritis were associated with less use of blood tests, nonrecommended medications and antibiotics. Use of nonrecommended medications was relatively low (6 percent) but varied by location and region, ranging from 1.5 percent of children in Northeastern urban hospitals to 16 percent of children in Southern rural hospitals. Overuse indicators, including selected blood, stool and rotavirus tests, were performed in 85 percent, 46 percent and 56 percent of children, respectively.

"Children admitted to hospitals in the 25th versus 75th percentile of patient volume had a 10 percent, 30 percent and 10 percent increased chance of having blood tests, nonrecommended medications, and antibiotics ordered, respectively," the authors write.

"In a nationally representative sample of hospitals that care for children with acute gastroenteritis, higher patient volumes were associated with greater adherence to established quality indicators," the authors conclude. "To ensure high-quality hospital care for all children, more research is needed to identify structural and organizational characteristics that drive quality for common pediatric conditions, regardless of hospital size."