YIELD FROM STOOL TESTING OF PEDIATRIC INPATIENTS

Objectives: To quantify the yield from stool testing in pediatric inpa tients and to identify criteria to test stool more deliberately withou t sacrificing diagnostic sensitivity. Design: A retrospective review w as performed of all stool cultures, ova and parasite examinations, and Clostridia difficile toxin assays performed on pediatric inpatients, aged 3 days to 18 years, at Thomas Jefferson University Hospital, Phil adelphia, Pa, for 1 year. Medical records were reviewed for positive c ases, each with 2 controls matched for age and test type. For this stu dy, the term admission refers to the interval between the times each p atient was admitted to and discharged from the hospital. Some patients had multiple stool tests sent to the laboratory during a single admis sion; some patients had more than I admission during the study period. Statistical analysis was performed using chi(2) analysis and the Stud ent 2-tailed t test with a commercially available statistical software package (Statworks, Cricket Software, Philadelphia). Results: Of 250 patient admissions to the hospital for which stool was cultured, 7 cul tures (2.8%) were positive. Of 63 patient admissions having ova and pa rasite testing, 1 (2%) had a positive result. Clostridia difficile tox in assays were performed on 40 patient admissions to the hospital, and 7 (18%) had a positive result. Only 18 (3.0%) of 598 of all test resu lts reviewed were positive. Costs of negative test results totaled $26 084. More patients (71%) with positive stool cultures than control pa tients (21%) had a temperature higher than or equal to 38 degrees C (c hi(2), P<.05); however, relying on this sign missed 29% of the childre n with bacterial infection. A white blood cell band count of at least 0.10 was 100% sensitive and 79% specific in identifying patients with positive stool culture. There was no statistically significant relatio nship between stool culture results and age, total white blood cell co unt or white blood cell segmented neutrophil count, and no relationshi p between C difficile toxin assay results and any of the above charact eristics. Clostrida difficile was the most common pathogen identified (6 of 9) in patients developing gastrointestinal symptoms after admiss ion; however, Salmonella enteritidis and Shigella sonnei were also sig nificant causes (3 of 9). Conclusions: There is low yield from stool t esting of pediatric inpatients; C difficile toxin assay has the highes t yield. Clostridia difficile testing is most valuable for children wi th nosocomial gastrointestinal symptoms, although other bacterial path ogens do cause nosocomial symptoms in children. More selective stool t esting could help us be more efficient with our patient care resources .