PEDIATRICS Vol. 76 No. 4 October 1985, pp. 551-556
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by DeWitt, T. G.
Right arrow Articles by McCarthy, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by DeWitt, T. G.
Right arrow Articles by McCarthy, P.

Clinical Predictors of Acute Bacterial Diarrhea in Young Children

Thomas G. DeWitt MD1, Kim F. Humphrey MPH1, and Paul McCarthy MD1

1 From the Departments of Pediatrics at the University of Massachusetts Medical Center, Worcester, and Yale University School of Medicine, New Haven, Connecticut

This prospective study assessed the value of presenting history, physical examination, and screening laboratory tests in predicting whether diarrhea in a young child is associated with a stool culture positive for a bacterial pathogen. Acutely ill children less than 4 years old were studied in a hospital outpatient setting. Two hundred patients were seen in a 9frac12-month period, which encompassed the seasons of summer, fall, and winter. One hundred ninety-five patients had cultures completed and twenty-nine (15%) had a bacterial pathogen isolated. The best predictive variable for a stool culture positive for a bacterial pathogen was the presence of polymorphonuclear cells in the stool, with a sensitivity of 85%, a specificity of 88%, and positive and negative predictive values of 59% and 97%, respectively. A cluster of three historical variables—abrupt onset of diarrhea, greater than four stools per day, and no vomiting before the onset of diarrhea—was identified that delineated a subpopulation of patients with an increased probability of having a stool culture positive for a bacterial pathogen (27% v 4% if any of the three variables was absent). It is suggested that these findings can be combined in a stepwise manner using the historical cluster as an initial screening, followed by examination for stool polymorphonuclear cells in the high probability subgroup, to identify those patients with a very high probability of having a bacterial pathogen isolated in their stool.

Key Words: bacterial diarrhea • stool cultures • decision analysis

Submitted on January 28, 1985
Accepted on March 7, 1985




This article has been cited by other articles:


Home page
 Arch. Dis. Child.Home page
K Armon, T Stephenson, R MacFaul, P Eccleston, U Werneke, and H. BAUMER
An evidence and consensus based guideline for acute diarrhoea management
Arch. Dis. Child., August 1, 2001; 85(2): 132 - 142.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
A. S. Gastanaduy and R. E. Begue
Acute Gastroentertis
Clinical Pediatrics, January 1, 1999; 38(1): 1 - 12.
[Abstract] [PDF]