Lo Vecchio Andrea, Liguoro Ilaria, Bruzzese Dario, Scotto Riccardo, Parola Luciana, Gargantini Gianluigi, Guarino Alfredo
From the *Section of Pediatrics, Department of Translational Medical Science; †Department of Public Health, University of Naples "Federico II", Napoli, Italy; ‡Department of Pediatrics, Hospital of Magenta, Azienda Ospedaliera "Ospedale Civile di Legnano", Magenta, Italy; and §Department of Pediatrics, Hospital of Lodi, Lodi, Italy.
Pediatr Infect Dis J. 2014 Nov;33(11):1103-8. doi: 10.1097/INF.0000000000000396.
The major burden of acute gastroenteritis (AGE) in childhood is related to its high frequency and the large number of hospitalizations, medical consultations, tests and drug prescriptions. The adherence to evidence-based recommendations for AGE management in European countries is unknown. The purpose of the study was to compare hospital medical interventions for children admitted for AGE with recommendations reported in the European Societies of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Infectious Diseases guidelines.
A multicenter prospective study was conducted in 31 Italian hospitals. Data on children were collected through an online clinical reporting form and compared with European Societies of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Infectious Diseases guidelines for AGE. The main outcomes were the inappropriate hospital admissions and the percentage of compliance to the guidelines (full >90%, partial >80% compliance) based on the number and type of violations to evidence-based recommendations.
Six-hundred and twelve children (53.6% male, mean age 22.8 ± 15.4 months) hospitalized for AGE were enrolled. Many hospital admissions (346/602, 57.5%) were inappropriate. Once admitted, 20.6% (126/612) of children were managed in full compliance with the guidelines and 44.7% (274/612) were managed in partial compliance. The most common violations were requests for microbiologic tests (404; 35.8%), diet changes (310; 27.6%) and the prescription of non-recommended probiotics (161; 14.2%), antibiotics (103; 9.2%) and antidiarrheal drugs (7; 0.6%).
Inappropriate hospital admissions and medical interventions are still common in the management of children with AGE in Italy. Implementation of guidelines recommendations is needed to improve quality of care.
儿童急性肠胃炎（AGE）的主要负担与其高发病率以及大量的住院治疗、医疗咨询、检查和药物处方有关。欧洲国家对基于证据的AGE管理建议的遵循情况尚不清楚。本研究的目的是将因AGE入院的儿童的医院医疗干预措施与欧洲儿科胃肠病学、肝病学和营养学会以及儿科传染病学会指南中报告的建议进行比较。
在31家意大利医院进行了一项多中心前瞻性研究。通过在线临床报告表收集儿童数据，并与欧洲儿科胃肠病学、肝病学和营养学会以及儿科传染病学会的AGE指南进行比较。主要结果是不适当的住院情况以及根据对循证建议的违反数量和类型得出的指南遵循率（完全遵循>90%，部分遵循>80%）。
纳入了612名因AGE住院的儿童（53.6%为男性，平均年龄22.8±15.4个月）。许多住院情况（346/602，57.5%）是不适当的。一旦入院，20.6%（126/612）的儿童得到了完全符合指南的治疗，44.7%（274/612）的儿童得到了部分符合指南的治疗。最常见的违规行为是进行微生物检测（404例；35.8%）、改变饮食（310例；27.6%）以及开具未推荐的益生菌（161例；14.2%）、抗生素（103例；9.2%）和止泻药（7例；0.6%）。
在意大利，对患有AGE的儿童进行管理时，不适当的住院和医疗干预仍然很常见。需要实施指南建议以提高医疗质量。
