Diagnosis

Bibliographic informationStudy type and evidence levelNumber of patientsPatient characteristicsIntervention and comparisonFollow-up and outcome measuresEffect sizeStudy summaryReviewer comments
Khuffash FA; Sethi SK; Shaltout AA;

198844

Kuwait
Study Type: Cross-sectional

Evidence level: 3
595 children. 5 children with Aeromonas hydrophilia were excluded from the comparison because of the small number.Children aged from under 1 year to 12 years
presence of gastroenteritis
hospitalised
Intervention: Clinical features of gastroenteritis

Duration of gastroenteritis by aetiological agent

Comparison: Comparisons of duration of diarrhoea are made between children with gastroenteritis due to different aetiological agents
Follow-up period: Clinical progress during hospitalisation and after discharge was recorded

Outcome Measures: Duration of diarrhoea
Frequency of clinical characteristics by aetiological pathogenMean Duration

Rotavirus 4.8 days
Salmonellae 12.3 days
E. Coli 6.8 days
Campylobacter 7.4 days
Shigellae 7.9 days
Rotavirus & Salmonella 12.9 days
Rotavirus & others 7.4 days
No pathogen 5.6 days
Overall mean 7.4 days

Mortality 0.7% (all from salmonella group)
Gastroenteritis due to rotavirus follows a benign course both in the developing and developed world

Although the overall number of participants is large, some of the groups have small numbers of children.
Because of the higher incidence of bacterial pathogens, the cases seem to have longer durations.
Uhnoo I; Olding- Stenkvist E; Kreuger A;

198651

Sweden
Study Type: Cross-sectional

Evidence level: 3
416 children (228 boys and 188 girls)Children below 15 years of age with acute gastroenteritis who attended the Department of Paediatrics.

Mean age 24.9 months
Median age 15 months
Intervention: Clinical features of gastroenteritis

Comparison: Comparisons of symptoms and signs of rotavirus infections with those of adenovirus, bacterial, mixed and non-specific infections.
Clinical features of children in relation to enteropathogens detected in stool

Mean duration of diarrhoea (in days) in relation to pathogens
Rotavirus vs. Adenovirus vs. Bacteria

Frequency of clinical features (%)

Diarrhoea: 98 vs. 97 vs. 100
Diarrhoea > 10 times daily: 21 vs. 22 vs. 36
Vomiting: 87 vs. 78 vs. 43
Vomiting > 5 times daily: 37 vs. 7 vs. 9
Fever: 84 vs. 44 vs. 69
Abdominal pain: 18 vs. 25 vs. 50
Blood present in stools: 1 vs. 3 vs. 41
Mucus present in stools: 17 vs. 19 vs. 26

Mean (SD) duration in days

Symptoms before hospital contact: 2.9 (0.2) vs. 5.3 (0.7) vs. 5.4 (0.6)
Diarrhoea: 5.9 (0.3) vs. 10.8 (1.7) vs. 14.1 (2.2)
Vomiting: 2.5 (0.1) vs. 3.2 (0.8) vs. 2.1 (0.3)
Hospital stay: 2.4 (0.2) vs. 3.6 (1.2) vs. 3.6 (1.2)
Clinical features of gastroenteritis with rotavirus, enteric adenoviruses and bacteria each exhibit patterns that could guide the experienced clinician to a presumptive diagnosis
Colomba C; Grazia SD; Giammanco GM; Saporito L; Scarlata F; Titone L; Arista S

200652

Italy
Study Type: Cross-sectional

Evidence level: 3
215 childrenChildren admitted with symptoms of acute diarrhoea (≥3 watery stools in a period of 24 hrs)Epidemiologic and clinical features of acute viral gastroenteritis

Comparison: Comparisons of symptoms and signs of viral infections with non-viral infections.
Comparison of Clinical features of children between thos with positive result and those without positive results of viral detection in stool.

Mean duration of diarrhoea (in days) in relation to pathogens
Children with single viral infection vs. with dual viral infection vs. without viral infection

Frequency of clinical features (%)

Diarrhoea ≥ 3 days: 58.7 vs. 71.4 vs. 63.1 (P < 0.005)
Vomiting: 71.2 vs. 61.9 vs. 43 (P < 0.0005)
Fever: 58.7 vs. 61.9 vs. 66.7 (P < 0.05)
Dehydrated children: 50 vs. 52.4 vs. 36.8 (P < 0.01)
Hospitalization ≥ 3 days: 37.5 vs. 47.6 vs. 368.6 (P > 0.05)
Conway SP; Phillips RR; Panday S;

199053

UK
Study Type: Cross-sectional

Evidence level: 3
1148 children (639 boys and 509 girls)All children below 16 years of age admitted to a hospital over a one year period with a diagnosis of gastroenteritis

55% children less than 1 year of age, 45% belong to social class V and 17% to social class IV
Frequency of pathogens isolated

Clinical features of children in relation to enteropathogens detected in stool and comparison of the features and treatment received in the hospital.

Biochemical abnormalities detected according to presence/absence of dehydration
Frequency of pathogens isolated from stool examination

Rotavirus: 31%
Samonella: 5%
Campylobacter: 3.2%
Enteropathogenic E.coli: 2%
Cryptosporidia: 1%
Shigella and C.difficile: <1% each
No pathogen: 55%

Comparison of clinical features
  1. Rotavirus vs. Protozoa vs. Bacteria vs. Mixed infection
    Mean frequency of stool/day: 5.9 vs. 6.1 vs. 7.4 vs. 7.7
    Frequency of vomiting in %: 92 vs. 84 vs. 54 vs. 75
  2. Bacteria + protozoa + mixed infection vs. rotavirus vs. no pathogen Stool with blood or mucus in %: 25 vs. 2.8 vs. 4.1 (P < 0.001)
    Stool frequency 4 per day in %: 30 vs. 11 vs. 7 (P < 0.001)
    % of children with diarrhoea settling in < 48 hrs: 39 vs. 52 vs. 67
    % of children with diarrhoea settling in 49–96 hrs: 30 vs. 32 vs. 16
    % of children with diarrhoea settling in ≥ 97 hrs: 31 vs. 16 vs. 16
Comparison of biochemical features between dehydrated children (n=101) and non- dehydrated children (n=1047)

Sodium > 145 mmol/l = 11% vs. <1% (P < 0.001)
Bicarbonate < 21 mmol/l = 72% vs. 55% (P < 0.001)
Urea > 7 mmol/l = 30% vs. 5% (P < 0.001)

% of gut pathogens identified in dehydrated vs. non-dehydrated children: 61% vs. 43% (P < 0.001)
Deivanayagam N; Mala N; Ashok TP; Ratnam SR; Sankaranarayanan VS;

199354

India
Study Type: Case–control

Evidence level: 2+
170 cases

340 controls

2 controls for each case, matched for age.
all participants were 1–23 months, admitted to the Institute of Child Health Madras for diarrhoea.

CASES
children with diarrhoea persisting more than 14 days at admission

CONTROLS
children with acute diarrhoea who had recovered within 7 days
Intervention: Risk factors for persistent diarrhoea are being investigated.

They include:
mother’ literacy
father’s literacy
diarrhoea within the past 3 months
pre-admission feeding pattern
container used for feeding
method of cleaning the bottle
nature of stool
frequency of stool
indiscriminate use of antimicrobials

dehydration
persistence of dehydration for>24 hours

nutritional status
vitamin A deficiency
associated illness
weight loss during study period

Comparison: Comparisons are made between cases and controls for each of the risk factors listed
Follow-up period: this is not reported

Outcome Measures: Odds Ratios for

mother’ literacy
father’s literacy
diarrhoea within the past 3 months
pre-admission feeding pattern
container used for feeding
method of cleaning the bottle
nature of stool
frequency of stool
indiscriminate use of antimicrobials

dehydration
persistence of dehydration for >24 hours
nutritional status
vitamin A deficiency
associated illness
weight loss during study period
Mother’s literacy
OR 1.3; 95% CI 0.8–1.9; P = 0.28

Mother’s literacy excluding invasive diarrhoea
OR 0.8; 95% CI 0.5–1.2; P = 0.34

Father’s literacy
OR 1.0; 95% CI 0.6–1.6; P = 0.91

Diarrhoea within the past 3 months
OR 0.5; 95% CI 0.3–1.0; P = 0.04

Preadmission feeding pattern
OR 1.0; 95% CI 0.7–1.5; P = 0.97

Container used for feeding
OR 0.9; 95% CI 0.6–1.5; P = 0.79

Method of cleaning the feeding bottle
OR 0.6; 95% CI 0.1–2.3; P = 0.33

Method of cleaning the feeding bottle excluding invasive diarrhoea
OR 0.3; 95% CI 0.03–1.7; P = 0.11

Nature of stool
OR 2.4; 95% CI 1.3–4.3; P = 0.003
Adjusted OR 2.4; 95% CI 1.3–4.3;

Frequency of stool
OR 1.7; 95% CI 1.1–2.5; P = 0.01
Adjusted OR 1.8; 95% CI 1.2–2.8

Frequency of stool excluding invasive diarrhoea

OR 1.6; 95% CI 1.0–2.4;
Adjusted OR 1.9; 95% CI 1.1–3.0

Indiscriminate use of antimicrobials

OR 2.5; 95% CI 1.6–3.8; P < 0.001
Adjusted OR 2.4; 95% CI 1.6–3.9

Indiscriminate use of antimicrobials excluding invasive diarrhoea

OR 2.6; 95% CI 1.6–4.2
Adjusted OR 2.8; 95% CI 1.7–4.8

CLINICAL FEATURES

Dehydration
OR 0.7; 95% CI 0.9–2.4; P = 0.78

Dehydration excluding invasive diarrhoea
OR 0.9; 95% CI 0.2–3.9; P = 0.54

Persistence of dehydration > 24 hours
OR 4.2; 95% CI 2.8–6.5; P < 0.001
Adjusted OR 1.4; 95% CI 1.2–1.7

Persistence of dehydration > 24 hours excluding invasive diarrhoea
OR 3.8; 95% CI 2.4–5.9; P < 0.001

Nutritional status
OR 2.7; 95% CI 1.9–4.1; P < 0.001
Adjusted OR 2.9; 95% CI 1.9–4.5

Nutritional status excluding invasive diarrhoea

OR 2.9; 95% CI 1.6–3.9
Adjusted OR 2.9; 95% CI 1.7–4.7

Vitamin A deficiency
OR 2.3; 95% CI 1.0–5.2; P = 0.06

Vitamin A deficiency excluding invasive diarrhoea
OR 2.3; 95% CI 1.0–5.7

Associated illness
OR 4.5; 95% CI 2.7–7.4; P < 0.001
Adjusted OR 2.1; 95 % CI 1.5–3.1;

Associated illness excluding invasive diarrhoea
OR 5.9; 95% CI 3.5–10.0;
Adjusted OR 2.1; 95% CI 1.4–3.1

Weight loss during study period
OR 15.6; 95% CI 6.5–39.1; P < 0.001

Weight loss during study period excluding invasive diarrhoea

OR 11.3; 95% CI 5.3–24.2; P < 0.001
Adjusted OR 11.5; 95% CI 5.4– 25.2
The risk factors strongly associated with persistent diarrhoea are:
malnutrition
stools with blood / mucus
stool frequency of > 10 / day
indiscriminate use of antimicrobials for acute diarrhoeas
associated illnesses like septicaemia, pneumonia and UTI, persistence of dehydration > 24 hours with appropriate fluid therapy
loss of weight during hospital stay

The risk factors shown to be strongly associated with persistent diarrhoea can influence the natural history of diarrhoea and should be carefully considered in examination and history taking.
Ellis ME; Watson B; Mandal BK; Dunbar EM; Mokashi A;

198457

UK
Study Type: Cross-sectional

Evidence level: 3
447 childrenChildren aged under 2 years admitted to hospital with infectious gastroenteritis over a 12 month period

Age distribution:
≤6 months: 210
7–12 months: 120
13–18 months: 86
19–24 months: 29
Frequency of pathogens isolated

Biochemical abnormalities detected in the admitted children
Frequency of pathogens isolated from stool examination

Viruses alone: 57%
Bacteria alone: 6%
Viruses & bacteria: 10%
No pathogen: 23%

Specific organisms isolated
Rotavirus: 34%
Other viruses: 53%
Samonella: 4.3%
Campylobacter: 5.1%
Enteropathogenic E.coli: 6.9%
Cryptosporidia: 1%
Shigella: 2%
C.difficile toxin: 4.9%

Incidence of dehydration and biochemical abnormalities

Moderate to severe dehydration: 14%
Sodium > 150 mmol/l = 0.8%
Bicarbonate < 15 mmol/l = 3%
Urea > 6 mmol/l = 8%
Jenkins HR; Ansari BM;

199058

UK
Study Type: Cross-sectional

Evidence level: 3
215 children (116 boys and 99 girls)All children admitted to four paediatric units in South Wales with acute gastroenteritis over a 12 month period

Age range: 2 weeks to 9 yrs with 61% < 1 year of age
Male: 54%
White: 96%
Frequency of pathogens isolated

Biochemical abnormalities detected in the admitted children
Frequency of pathogens isolated from stool examination

Viruses alone: 30%
Bacteria alone: 14%
Viruses & bacteria: 5%
No pathogen: 42%

Specific organisms isolated
Rotavirus: 25%
Other viruses: 5%
Samonella: 1.9%
Campylobacter: 5.1%
Enteropathogenic E.coli: 4.2%
Cryptosporidia: 6%
Shigella: 1.9%

Incidence of dehydration and biochemical abnormalities

> 5% dehydration: 7% (15/215)
Sodium > 145 mmol/l = 0.9% (2/215)
Bicarbonate < 15 mmol/l = 6% (13/215)
Urea > 6 mmol/l = 7.9% (17/215)
Cunliffe NA; Allan C; Lowe SJ; Sopwith W; Booth AJ; Nakagomi O; Regan M; Hart CA;

200760

UK
Study Type: Survey
Determination of the presence of rotavirus in stool samples by enzyme immunoassay

Evidence Level: 3
stool samples from an n = 234 childrenChildren (age 1– 168 months, median age 10 months) with acute gastroenteritis who had been hospitalised between January and May 2006The presence of rotavirusRotavirus was detected in 17/91 cases (19%) of the healthcare -associated acute gastroenteritis and 54/152 cases (36%) of community acquired acute gastroenteritisRotavirus is an important cause of healthcare -associated acute gastroenteritis in a large paediatric hospitalThis is survey data and thus is graded as evidence level 3.

It is important to consider that this a small sample from one hospital and the data may not necessarily be extrapolated.

The focus of the study was the healthcare-acquired rotavirus but this guideline is concerned with the community acquired rotavirus which was 36%
Froggatt PC; Vipond IB; Ashley CR; Lambden PR; Clarke IN; Caul EO;

200459

UK
Study Type: Survey

Evidence Level: 3
n = 3172 Sporadic stool samples (PHLS) from children under the age of seven with gastroenteritis

n = 1,360 stool samples from outbreaks of gastroenteritis
Clinical specimens (usually stool but sometimes vomit) from cases of gastroenteritis in children under the age of seven years and from sporadic outbreaks of gastroenteritis (unclear if all paediatric)

All South west and South Wales region
1999–2000 winter season
Intervention: Stool samples were tested using
electron microscopy for viral pathogens

Enzyme-Immuno Assay (EIA) and Polymerase Chain Reaction PCR for Norovirus

EIA for rotavirus

Comparison: Results of sporadic testing of stools and stools from outbreaks of gastroenteritis
Identification of causative agents focusing on norovirusResults of sporadic cases

rotavirus 21.6%
norovirus 10.3%
adenovirus 3.9%
astrovirus 3.1%
calicivirus 0.2%

62.3% were negative tests

Results of the outbreaks
rotavirus 3.9%
norovirus 63.9%
adenovirus 0.4%
astrovirus 0.4%

32.6% were negative tests
Norovirus was second most common viral agent in sporadic childhood gastroenteritis indicating it has a significant roleThis is a surveillance study thus is graded as evidence level 3.

It must be considered that this a localised study which was conducted nearly 10 years ago.

The funding of this study was not declared
Gomara MI; Simpson R; Perault AM; Redpath C; Lorgelly P; Joshi D; Mugford M; Hughes CA; Dalrymple J; Desselberger U; Gray J;

200862

UK
Study Type: Survey
Evidence Level: 3
n = 685 stool samples of which
n = 223 in a structured surveillance cohort (GP based)
n = 203 in a community cohort (referred to hospital from GP)
n = 259 in a hospital cohort (in patient)
Children under the age of 6 years with acute gastroenteritis in East Anglia UK between 2000 to 2003Intervention: Stool samples were investigated for the presence of viruses by PCR for the detection of
enteric adenovirus
astrovirus
norovirus
Grp A & C rotavirus
sapovirus

Comparison: none
presence of viral pathogens in the stool samples

enteric adenovirus
astrovirus
norovirus
Grp A & C rotavirus
sapovirus
A viral agent was detected in 367/685 samples (53.6%)

Rotavirus was the most common in all three groups followed by norovirus and enteric adenovirus

Structured surveillance n(%)
rotavirus A 106(47.5%)
norovirus 31(13.9%)
adenovirus 20 (9.0%)
astrovirus 11(4.9%)
sapovirus 2 (0.9%)
rotavirus 1(0.4%)

Community cohort n(%)
rotavirus A 60(29.6%)
norovirus 18(8.9%)
adenovirus 26(12.8%)
astrovirus 4(2.0%)
sapovirus 8(3.9%)
rotavirus 2(1.0%)

Hospital cohort n(%)
rotavirus A 59(22.8%)
norovirus 36(13.9%)
adenovirus 20 (7.7%)
astrovirus 7(2.7%)
sapovirus 5(1.9%)
rotavirus 2(0.8%)

Multiple viruses were found in 8% of cases
Rotavirus was the most common pathogen found in all three cohorts followed by norovirus and enteric adenovirusThis was a surveillance survey and was graded as evidence level 3.

It should be considered that this is a localised small study although it is fairly recent data.

The study was funded by the NHS executive Eastern Region, research and Development Directorate
Van DP; Giaquinto C; Maxwell M; Todd P; Van der WM; REVEAL Study Group.;

200761

Multi-centre Europe study
Study Type: Other

Evidence Level: 3
n = 1010 stool samplesChildren under the age of 5 years with acute gastroenteritis seeking health care in UK hospitals during a 12 month period (part of multicentre pan European project)Intervention: Identification of rotavirus by ELISA and PCR

Comparison: none
results were presented from three setting:

Hospital
Emergency department
Primary care setting

% of samples positive for rotavirus given as observed and expected (if ELISA test was missing, same proportion of rotavirus was assumed)
No(%) of + rotavirus ELISA

Hospital
observed 39(60.9%)
estimated 51(60.7%)

Emergency department
observed 22(59.5%)
estimated 33(60%)

Primary care setting
observed 15 (31.9%)
estimated 279(32%)

Total
estimated 363(35.9%)
Rotavirus is an important pathogen in acute gastroenteritis in children. The incidence rate of rotavirus is ~60% in secondary health care and ~30% in the primary care setting.This is a surveillance study so is graded as evidence level 3.

The focus of this multicentre pan European study was to look at rotavirus genotypes across Europe in view of vaccine development

The incidence rate of rotavirus is ~60% in secondary health care and ~30% in the primary care setting. However, it is important to note that the was a high proportion of estimated cases in the community data.

This study was funded by Sanofi Pastuer MSD
Wheeler JG; Sethi D; Cowden JM; Wall PG; Rodriques LC; Tompkins DS; Hudson MJ; Roderick PJ

199911

UK
Study Type: Survey

Evidence Level: 3
n = 459, 975 patients served by 70 general practices in England

plus community surveillance of 9776 randomly selected patients
Patients (all ages) registered at a GP practice and who either attended the practice with an infectious intestinal disease or were surveyed in the community (dates unclear)Intervention: Incidence of infectious intestinal disease in community and reported to general practice

Comparison: GP and community data is compared to the National Laboratory Surveillance data
Main outcome measure: incidence of infectious intestinal disease at 70 GP practices and in the community

No of cases with identified pathogen divided into bacterial, viral or protozoan
Community data : 781 cases
Incidence of 19.4/100 person years

GP: 8770 cases
Incidence of 3.3/100 person years

Types of pathogen Community

One case sent to national surveillance for every:
6.2 stools send for lab investigation
1.4 laboratory identifications
23 cases in GP
136 community cases

Community cases vs national surveillance
Salmonella 3.2 :1
Campylobacter 7.6 :1
Rotavirus 35 : 1
Round, structured viruses 1562 :1
Infectious intestinal disease occurs in 1 in 5 people each year of whom 1 in 6 presents to a GP

Proportion of cases not reported by national surveillance is large and varies widely per organism
This study is described by the authors as a population based community cohort incidence study but is essentially survey data and is therefore graded as evidence level 3.

The specific date of the data is unclear but is ~10 years old. Although incidence data is given for bacterial, viral and protozoan agents, the key result of this study is the disparity between the GP/community based incidence of infectious intestinal disease and that reported by the national laboratory surveillance.

This study was funded by the Department of Health
Borgnolo G; Barbone F; Guidobaldi G; Olivo G;

199665

Italy
Study type: Diagnostic study

Evidence Level: 2
111 childrenChildren aged between 1 and 60 months admitted to a hospital with acute diarrhoea lasting more than 12 hours and less than 15 days

Bacterial: 53 (48%)
Viral: 35 (31%)
Culture-negative: 23 (21%)

Exclusion: Children with chronic gastrointestinal diseases such as cow’s milk protein intolerance, Crohn’s disease, gastro- oesophageal reflux or chronic diseases
  1. Comparison of acute phase reactant levels in bacterial, viral and culture-negative cases
  2. Association and diagnostic accuracy of CRP at different thresholds in the differentiation of bacterial and viral gastroenteritis
Reference standard: Stool culture
  1. Comparison of mean ± SD levels for CRP (mg/l)
    bacterial vs. viral
    44 ± 44 vs. 6.2 ± 7.0 (P < 0.001)
    bacterial vs. culture- negative
    44 ± 44 vs. 19.5 ± 20
    viral vs. culture-negative
    6.2 ± 7.0 vs. 19.5 ± 20
    Comparison of mean ± SD levels for ESR (mm/hr)
    bacterial vs. viral
    25 ± 15 vs. 15 ± 9 (P < 0.05)
    Comparison of mean ± SD levels for blood leucocyte count (× 109/l)
    bacterial vs. viral vs. culture-negative
    9.9 ± 4.2 vs. 10.7 ± 4.7 vs. 10.1 ± 4.7
  2. Association and diagnostic accuracy of CRP at different thresholds in the differentiation of bacterial and viral gastroenteritis
    At CRP level ≥ 12 mg/l
    OR: 25.8 (7.6 to 87.9)
    AROC: 0.83
    At CRP level ≥ 20 mg/l
    OR: 46.4 (5.9 to 364.9)
    AROC: 0.77
    At CRP level ≥ 35 mg/l
    OR: 26.9 (3.4 to 212.1)
    AROC: 0.70
Population representative with well defined exclusion
Test and reference test described adequately
Reference test is a standard one
Blinding not specified
Lin CH; Hsieh CC; Chen SJ; Wu TC; Chung RL; Tang RB;

200666

Taiwan/China
Study type: Diagnostic study

Evidence Level: 3
56 childrenChildren admitted with acute gastroenteritis, of whom 21 had rotavirus (by Rotaclone® test), 18 had bacterial infections (by stool culture with salmonella species isolated predominantly) while 17 children were recruited as controls.
Mean age 2.5 years

Exclusion: Children with chronic disease or history of persistent/intractable diarrhoea
  1. Comparison of CRP, IL-6 and IL-8 levels in bacterial, viral and control cases
  2. Diagnostic accuracy of CRP, IL-6 and IL-8 at different thresholds in the differentiation of bacterial and viral gastroenteritis
Reference standard: Stool culture
Comparison of mean ± SD levels for CRP (mg/l)
bacterial vs. viral
9.1 ± 6.6 vs. 1.4 ± 1.2 (P < 0.001)
bacterial vs. control
9.1 ± 6.6 vs. 0.9 ± 0.8 (P < 0.001)

Comparison of mean ± SD levels for IL-6 (pg/ml)
bacterial vs. viral
45.3 ± 49.6 vs. 7.9 ± 2.7 (P < 0.001)
bacterial vs. control
45.3 ± 49.6 vs. 5.3 ± 3.0 (P < 0.001)

Comparison of mean ± SD levels for IL-8 (pg/ml)
bacterial vs. viral
99.9 ± 81.9 vs. 54.3 ± 32.2 (P = 0.059)
bacterial vs. control
99.9 ± 81.9 vs. 22.4 ± 6.3 (P < 0.001)

2) Diagnostic accuracy at different thresholds in the differentiation of bacterial and viral gastroenteritis

AROC for
CRP 0.897
IL-6 0.828
IL-8 0.677

At CRP level ≥ 2 mg/dl
Sensitivity: 83%
Specificity: 76%

At IL-6 level ≥ 10 pg/ml
Sensitivity: 78%
Specificity: 86%

At IL-8 level ≥ 70 pg/ml
Sensitivity: 50%
Specificity: 67%
Population not representative
Reference test not described adequately
Reference test is a standard one
Blinding not specified
Marcus N; Mor M; Amir L; Mimouni M; Waisman Y;

20067

Israel
Study type: Diagnostic study

Evidence Level: 3
44 childrenChildren admitted to the emergency department of a tertiary hospital with symptoms of vomiting, diarrhoea more than three episodes and fever, and who underwent laboratory testing.

Age range 4 days to 17 years, median age of 2.4 years

Exclusion: not defined
Comparison of mean CRP levels between bacterial and viral gastroenteritis

Diagnostic accuracy of Quick-read CRP test at different thresholds in the differentiation of bacterial and viral gastroenteritis

Reference standard: Stool culture
  1. Comparison of mean ± SD levels for CRP (mg/l)
    bacterial vs. viral
    223.8 ± 150.3 vs. 30.0 ± 50.0 (P < 0.001)
  2. Diagnostic accuracy of QR-CRP at cut-off value of > 95 mg/L (best value derived from ROC curve)
Population not representative
Reference test not described adequately and not carried out in all children
Reference test is a standard one
Blinding not specified

From: Evidence tables

Cover of Diarrhoea and Vomiting Caused by Gastroenteritis
Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years.
NICE Clinical Guidelines, No. 84.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2009 Apr.
Copyright © 2009, National Collaborating Centre for Women’s and Children’s Health.

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