ABSTRACT

Introduction:

This study aimed to evaluate pediatric emergency department visits due to rotavirus- associated acute gastroenteritis by the means of laboratory parameters, length of stay at hospital, hospitalization rates and revisit rates in 72 hours after first admission.

Methods:

A matched case-control study was conducted. Pediatric patients under the age of 18 years who presented to the pediatric emergency department with acute diarrhea (three or more times/day) with/out vomiting between 1^st January and 30^th June 2018 were included. The study group was composed of patients who had positive stool rotavirus antigen test while the control group consisted of equal number of randomly selected age and gender matched patients whose stool rotavirus antigen tests were negative.

Results:

A total of 2.834 patients had stool rotavirus antigen test done. Stool rotavirus positivity was 5.3% (n=149). There was no difference between the groups according to age (2.5±2.0 year vs. 2.5±2.0 year, p=0.657) and gender (53% male vs. 55% male, p=0.816). Diarrhea and vomiting co-occurrence was significantly more frequent in the study group (87% vs. 55%, p<0.001). Dehydration symptoms were more common in the study group (57% vs. 27.5%, p<0.001). Differences between laboratory parameters such as pH (7.37±0.06 vs. 7.39±0.06, p=0.009), HCO₃ (15.7±3.5 mmol/L vs. 17.4±3.5 mmol/L, p<0.001), BUN (31.9±16.0 mg/dL vs. 25.4±11.3 mg/dL, p<0.001) and uric acid (7.0±2.8 mg/dL vs. 5.7±2.5 mg/dL, p<0.001) were significant. Eight patients in the study group had co-infections with Adenovirus and/or amoeba. The study group had significantly longer hospital stay than the control group (12.3±14.2 hours vs. 7.6±10.4 hours, p=0.029). Hospitalization rates (38.9% vs. 18.1%, p<0.001) as well as revisit rates (14.1% vs. 5.4%, p=0.018) were also significantly higher in the study group.

Conclusion:

Vomiting, acute diarrhea and dehydration are leading symptoms of rotavirus gastroenteritis in childhood and rotavirus positivity is associated with longer hospital stay, higher hospitalization and revisit rates.

Keywords: Child, emergency department, gastroenteritis, rotavirus infections

References

Bhutta ZA. Acute gastroenteritis in children. In: Kliegman R, editör. Nelson textbook of Pediatrics. 19 ed. Philadelphia: Elsevier/Saunders, 2011:1323-39.

Akan H, İzbırak G, Gürol Y, Sarıkaya S, Gündüz TS, ve ark. Adenovirus frequency among patients with acute gastroenteritis and their relationship to clinical parameters: a retrospective study in Turkey. Asya Pasifik Aile Hekimliği. 2009;8:8.

Rotavirus. https://www.who.int/immunization/diseases/rotavirus/en (son erişim tarihi: 01.02.2019).

Hart CA, Cunliffe NA. Diagnosis and causes of viral gastroenteritis. Curr Opin Infect Dis. 1996;9:333-9.

Biçer S, Sahin GT, Koncay B, Yavuzcan D, Gemici H, ve ark. Çocuk Acil Servisinde Saptanan Rotavirüs Gastroenteriti Olgularının Sıklığı/Frequency of Gastroenteritis in Pediatric Emergency Department. Cocuk Enf Derg. 2008;2:96-9.

Ceyhan M, Alhan E, Salman N, Kurugol Z, Yildirim I, ve ark. Multicenter prospective study on the burden of rotavirus gastroenteritis in Turkey, 2005-2006: a hospital-based study. The Journal of infectious diseases. 2009;200:234-8.

Tapisiz A, Demirdag TB, Cura Yayla BC, Gunes C, Ugraş Dikmen AU, ve ark. Rotavirus infections in children in Turkey: A systematic review. Reviews in medical virology. 2019;29:2020.

Karampatsas K, Osborne L, Seah ML, Tong CYW, Prendergast AJ. Clinical characteristics and complications of rotavirus gastroenteritis in children in east London: A retrospective case-control study. PLoS ONE. 2018;13:194009.

Karadag A, Acikgoz ZC, Avci Z, Catal F, Gocer S, ve ark. Childhood diarrhoea in Ankara, Turkey: Epidemiological and clinical features of rotavirus-positive versus rotavirus-negative cases. Scand J Infect Dis. 2005;37:269-75.

Faria Pereira, Deborah Hsu. Chapter 18 Diarrhea. In: Bachur RG and Shaw KN (Ed.): Fleisher & Ludwig’s textbook of pediatric emergency medicine. Baltimore, Lippincott Williams & Wilkins, 2015;7:352.

Jauregui J, Nelson D, Choo E, Stearns B, Levine AC, et al. External validation and comparison of three pediatric clinical dehydration scales. PloS One. 2014;9:1-6.

Bicer S, Col D, Ciler Erdag G, Giray T, Gurol Y, ve ark. A Retrospective Analysis of Acute Gastroenteritis Agents in Children Admitted to a University Hospital Pediatric Emergency Unit. Jundishapur J Microbiol. 2014;7:e9148.

Aldemir-Kocabaş B, Karbuz A, Özdemir H, Tural-Kara T, Tapısız A, ve ark. Complications with rotavirus: A single center experiences. Turk J Pediatr. 2016;58:602-8.

Albano F, Bruzzese E, Bella A, Cascio A, Titone L, et al. Rotavirus and not age determines gastroenteritis severity in children: a hospital-based study. Eur J Pediatr. 2007;166:241-7.

Fruhwirth M, Heininger U, Ehlken B, Petersen G, Laubereau B, et al. International variation in disease burden of rotavirus gastroenteritis in children with community- and nosocomially acquired infection. Pediatric Infect Dis J. 2001;20:784-91.

Johansen K, Bennet R, Bondesson K, Eriksson M, Hedlund KO, et al. Incidence and estimates of the disease burden of rotavirus in Sweden. Acta Paediatric. 1999;88(Suppl 426):20-3.

Matson DO, Estes MK. Impact of rotavirus infection at a large pediatric hospital. The Journal of İnfectious Diseases. 1990;162:598-607.

Mrukowicz JZ, Krobicka B, Duplaga M, Kowalska-Duplaga K, Domanski J, et al. Epidemiology and impact of rotavirus diarrhoea in Poland. Acta Paediatric. 1999;88(Suppl):53-60.

Rivest P, Proulx M, Lonergan G, Lebel MH, Bedard L. Hospitalizations for gastroenteritis: the role of rotavirus. Vaccine. 2004;22:2013-7.

Rotavirus Associated Acute Gastroenteritis in the Pediatric Emergency Department: A Matched Case-control Study

ABSTRACT

References