An evidence and consensus based guideline for acute diarrhoea management

Objective-To develop an evidence and consensus based guideline for the mana gement of the child who presents to hospital with diarrhoea (with or withou t vomiting), a common problem representing 16% of all paediatric medical at tenders at an accident and emergency department. Clinical assessment, inves tigations (biochemistry and stool culture in particular), admission, and tr eatment are addressed. The guideline aims to aid junior doctors in recognis ing children who need admission for observation and treatment and those who may safely go home. Evidence-A systematic review of the literature was performed. Selected arti cles were appraised, graded, and synthesised qualitatively. Statements on r ecommendation were generated. Consensus-An anonymous, postal Delphi consensus process was used. A panel o f 39 selected medical and nursing staff were asked to grade their agreement with the generated statements. They were sent the papers, appraisals, and literature review. On the second and third rounds they were asked to re-gra de their agreement in the light of other panellists' responses. Consensus w as predefined as 83% of panellists agreeing with the statement. Recommendations-Clinical signs useful in assessment of level of dehydration were agreed. Admission to a paediatric facility is advised for children wh o show signs of dehydration. For those with mild to moderate dehydration, e stimated deficit is replaced over four hours with oral rehydration solution (glucose based, 200-250 mOsm/l) given "little and often". A nasogastric tu be should be used if fluid is refused and normal feeds started following re hydration. Children at high risk of dehydration should be observed to ensur e at least maintenance fluid is tolerated. Management of more severe dehydr ation is detailed. Antidiarrhoeal medication is not indicated. Validation-The guideline has been successfully implemented and evaluated in a paediatric accident and emergency department.