PRACTICE GUIDELINES FOR ORDERING STOOL OVA AND PARASITE TESTING IN A PEDIATRIC POPULATION

A comprehensive utilization review was done of all stool ova and paras ite examinations performed at a pediatric hospital during a 3-year per iod from June 1, 1989 to July 1, 1992, A total of 2,652 stool specimen s were surveyed from 1,532 children. Forty-one percent (1,081) of the workload was from inpatients, 37% (976) was from emergency room (ER) v isits/other outpatients, and 22% (233) was from patients attending the gastroenterology (GI) clinic, The prevalence of enteric parasites in hospitalized children was 4% (35 of 829) compared to rates of 10% (47 of 470) and 13% (30 of 233) for children attending the ER/other outpat ient clinics and GI clinic, respectively. Giardia lamblia was found mo st often (31% (45 of 146)), followed by Dientamoeba fragilis (23% [33 of 146]), Entamoeba call (16% [24 of 146]), Blastocystis hominis (13% [19 of 146]), Cryptosporidium (8% [12 of 146]), Endolimax nana (4% [6 of 146]), Enterobius vermicularis (2% [3 of 146]), Hymenolepis nana (2 % [3 of 136]), and Iodamoeba buetschlii(1% [1 of 146]), Most children were colonized/infected with a single parasite (85%) with a much small er number having two or more parasites. Only nine children (6%) who we re immunocompetent and hospitalized for more than 4 days were found to have enteric parasites. Over the past 18 months, significant sustaina ble cost savings have resulted from the implementation of practice gui delines for ordering pediatric stool ova and parasite examinations.