Perception and practice on the management of pediatric diarrhea in Thailand

Abstract

Background: Various observational and survey-based studies have shown suboptimal adherence to clinic practice guidelines, on management of pediatric diarrhea in Thailand. Objective: To define clinical practice of acute diarrhea in young children at a quaternary care teaching hospital, and to determine factors associated with the management. Materials and Methods: The authors initially reviewed the medical records of 1,500 children aged one month to five years with a diagnosis code of acute diarrhea between January 2017 and December 2018. The authors excluded children who received treatment from other centers or had other final primary diagnosis. This resulted in 802 cases, from which the authors collected presenting symptoms, investigations, and management. Results: The median age was 16 months (IQR 9, 29). Most children had no documentation of dehydration status (60%) and did not have mucous or blood in their stools (80%). Blood or stool tests were performed in less than 20% of the cases. Advice on lactose avoidance was noted in 16%, while antibiotics and hospital admission were noted in less than 10%. Domperidone was prescribed in 42%, while ondansetron was given in 8.7%. Multivariate logistic regression analyses showed various independent factors associated with lactose avoidance including age of less than 24 months, type of physician, vomiting, and hospital admission, antibiotic used when there was high grade fever of 39℃ or higher, mucous bloody stools, performed blood culture, and stool culture, and hospital admission when there was moderate dehydration, complete blood count, and performed stool culture. Conclusion: Recording dehydration status is suboptimal. Low rates of investigations complied with most clinical scenarios. Findings on the pediatric acute diarrhea-related management may provide future opportunities to improve education and further conduct quality improvement projects among clinicians.