G539(P) Are we requesting too many stool cultures in paediatrics? An experience from primary and secondary care

S Fernandes Lucas, A Singh, D Kunhanna, F Awadalla, J Ahmed
2020 Abstracts   unpublished
previous admissions and psychosocial assessments or referrals made were collected. Home postcodes were matched to local authority districts and mean index of multiple deprivation decile was calculated for that area, with 1 being the most deprived. Results Two hundred and thirty-seven cases of violent injury were included; 94.5% of cases were male and the mean age was 19.4 years. The local authority district in which the highest number of victims resided had a mean index of multiple deprivation
more » ... core of 3.7. Of all cases, only two patients received a full HEEADSSS assessment. 63.3% of individuals received a form of psychosocial referral, and 15.9% of these referrals were to third sector organisations. 8% of victims had been previously stabbed. Of those that had presented to the same major trauma centre in the past due to a stabbing, none held a recorded HEEADSSS assessment and 25% received no form of psychosocial referral nor intervention. Conclusion There continues to exist a prevalence of youth violence predominantly against young males. HEEADSSS assessment methods can be optimised to improve yield and identify adolescents at higher risk of sustaining injury. Screening must be followed up with timely and appropriate innovative interventions, suited to individual social circumstances, to prevent reoccurrence of violent incidents. Aims Finding the causative organism does not usually change the management of acute infective gastroenteritis, hence investigations such as stool culture should only be performed in selective cases. We intended to find if General Practitioners and Paediatricians were requesting stool cultures appropriately as recommended by the NICE guidelines for the diagnosis and management of diarrhoea and vomiting caused by gastroenteritis in children under 5. The guidelines recommend the performance or consideration of performance of stool microbiological investigations in specific cases, for instance in the presence of blood and/or mucous in stool. Methods Data was collected retrospectively from children under 5 years of age who had stool cultures performed over a period of 6 months (May 2018 to October 2018) in their local hospital or GP practice. The list of patients was provided by the laboratory and the information about the clinical indications and results was collected via the Information Technology system shared between primary and secondary care. The information about management was obtained from GP surgeries and hospital records. Results A total of 334 stool samples (GP practices=260 and Hospital=74) were sent for culture. The requests were inappropriate for the majority of patients with an overall of 58% (62% in community vs. 45% in hospital). Bacterial growths were observed in 7 samples (3 salmonella and 4 campylobacter). From all the appropriate requests (139), 4.3% were positive for bacterial growth and 0.7% were treated with antibiotic therapy. From the inappropriately requested samples (195), 0.5% were positive for bacterial growth with no patient receiving antibiotic treatment. Conclusion A significant number of stool culture requests by primary and secondary care did not follow the NICE recommendations. Inappropriate requests were more prevalent in primary than secondary care. There is a scope to investigate the reason for this difference. The probability of diagnosing a bacterial growth in a stool culture was significantly increased by approximately 8 times where recommendations were followed. Requesting investigations appropriately would also decrease unnecessary workload and reduce the burden on NHS finances.
doi:10.1136/archdischild-2020-rcpch.457 fatcat:irbo6zbdaffblahkywt7re4dsm