Guidelines on acute gastroenteritis in children: a critical appraisal of their quality and applicability in primary care

van den Berg, José; Berger, Marjolein Y

doi:10.1186/1471-2296-12-134

Table 5 Recommendations on diagnosis and treatment based on consensus.

From: Guidelines on acute gastroenteritis in children: a critical appraisal of their quality and applicability in primary care

	Guidelines
	ARM	CDC	ESP	CPS	WGO	NHG	CCH	NICE
AGREE domain score 'rigour of development' (%)	88.1	35.7	90.5	38.1	28.6	66.7	85.7	88.1
GP in guideline development team?	No	No	No	No	No	Yes	No	Yes
DIAGNOSIS									Consistent yes/no
Patients should be seen by physician if:		$	$			$		$	n = 4 ^#
They have risk factors for dehydration:
Young age		+	+					+	Y^•
Low birth weight/premature birth		+						+	N
Fever		+				+			N
Stopped breastfeeding								+	N
High output*		+	+			+		+	Y^•
Persistent vomiting/>2 vomits per 24 h		+	+					+	Y^•
Signs of malnutrition								+	N
Reported signs of severe dehydration		+				+		+	Y^•
Fluid losses exceed intake						+			N
Not offered/able to tolerate supplemented fluids/suboptimal response		+						+	N
Signs of severe cause for diarrhea/underlying disease		+	+			+		+	Y^•
Family circumstances		+						+	N
Blood tests and stool cultures	$	$	$		$	$	$	$	n = 7 ^#
Should not be routinely performed	+	+	+		+	+	+	+	Y^•
Perform stool culture if:	$	$	$		$	$		$	n = 6 ^#
Dehydrated or febrile patients					+				N
Sick patients with dysentery ^¥	+	+	+			+		+	Y^•
Blood/pus in stool	+				+				N
Immuno-compromised patients			+			+		+	Y^•
Patients with high infectivity for others						+			N
In case of outbreak			+						N
Recently traveled abroad	+					+		+	Y^•
To verify another etiology/uncertain diagnosis/if no improvement after 7 days			+					+	N
MANAGEMENT
Refer/admit to hospital if	$	$	$		$	$		$	n = 6 ^#
Social/logistic concerns	+	+	+		+	+		+	Y^•
Failure of initial rehydration	+	+	+		+	+		+	Y^•
Suspected alternative serious diagnosis	+	+	+		+	+		+	Y^•
Shock/severe dehydration		+	+		+	+			Y^•
High risk of dehydration		+	+			+			N
Intractable/persistent vomiting		+							N
Vomiting		$		$		$			n = 3 ^#
is not a contraindication for ORS		+		+		+			Y^•
Do not give ORS if protracted vomiting despite small frequent feeding				+					N

§ : Guidelines making a recommendation on this subject
* = > 6 diarrheal stool in 24 h, or > 3 vomits in 24 h or watery diarrhea > 6 times a day > 3 days (<2 years: > 1 day)
^¥ Dysentery = diarrhea with mucus and/or blood in stool, with fever and abdominal pain
# = number of guidelines making a recommendation on this subject
+ = recommended
• = a general practitioner was present in at least one guideline production

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